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Organization
FOOTPRINTS OUTREACH AND SUPPORT
Active
Organization
FOOTPRINTS OUTREACH AND SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RAY CANTRELL APSS, CPRS, TRADPSS (EXECUTIVE DIRECTOR)
(270) 846-6335
Entity
Organization
Contact information
Practice address
618 MCELWAIN CT, BOWLING GREEN, KY 42101-3524
(270) 846-6335
Mailing address
508 CLEARVIEW ST, FRANKLIN, KY 42134-2037
(270) 846-6335
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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