# FOOTHILLS ACADEMY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Otter Creek, Community Based Interventions
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114291879
- **Authorized official:** SAMANTHA ANN SIMMONS LPCC, LCADC (DIRECTOR)
- **Authorized official phone:** (606) 343-0216

## Contact information

- **Practice address:** 80 ROLLING HILLS BLVD, MONTICELLO, KY 42633-9005
- **Practice address phone:** (606) 343-0216
- **Practice address fax:** (606) 343-0224
- **Mailing address:** 80 ROLLING HILLS BLVD, MONTICELLO, KY 42633-9005
- **Mailing address phone:** (606) 343-0216
- **Mailing address fax:** (606) 343-0224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 500595 | KY | Yes |
| 3245S0500X | Children's Substance Abuse Rehabilitation Facility | 500595 | KY | — |

## Other

- **Enumeration date:** 02/28/2012
- **Last updated:** 05/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100317630 | — | KY |