Green Meadows Wellness Center One, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GREEN MEADOWS WELLNESS CENTER ONE, LLC

Practice address

8554 Ky 1232
Corbin, KY 40701-6417

Phone

(606) 261-7622

Fax

(606) 261-7312

NPI assigned

Dec 17, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Billy Fitch

Title

Business Manager

Phone

(606) 309-1291

Specialties & licenses 13

Addresses

Other identifiers 4

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diane Elizabeth Hughlett, M.ED. NCC

  • Mental Health Counselor
  • Corbin, KY
  • NPI 1134426703
  NPD
• Timothy William Smith, LPCA

  • Professional Counselor
  • Corbin, KY
  • NPI 1386518710
  NPD
• April Rena Faulkner, LPCC

  • Mental Health Counselor
  • Corbin, KY
  • NPI 1841419215
  NPD (past)
• Reba Ann Moore, PSY.S.

  • Intellectual & Developmental Disabilities Psychologist
  • Corbin, KY
  • NPI 1659546638
  NPD (past)
• Sara Michelle Smith

  • Mental Health Counselor
  • Corbin, KY
  • NPI 1568980100
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1902377864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8554 KY 1232",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407016417",
            "telephone_number": "606-261-7622",
            "fax_number": "606-261-7312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8554 KY 1232",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407016417",
            "telephone_number": "606-261-7622",
            "fax_number": "606-261-7312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1776 Meadow Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Rockholds",
            "state": "KY",
            "postal_code": "407599564",
            "country_code": "US",
            "telephone_number": "606-261-7622",
            "fax_number": "606-261-7312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREEN MEADOWS WELLNESS CENTER ONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "FITCH",
        "authorized_official_first_name": "BILLY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "606-309-1291"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100406190",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100606760",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720730021",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100360730",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Gray
• Kendra Rachelle Gray, DO
• Misti Gray
• Richi Michele Gray, NP
• Tara Gray
• Allison Green
• Cassie Green
• Deborah Janelle Green, BS
• Gary Wayne Green, LPCA
• Hannah Elizabeth Greene, BS

• Clinical Psychologist in Corbin, KY
• Providers in Corbin, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.