# FOOTPRINTS OUTREACH AND SUPPORT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780277293
- **Authorized official:** MR. MICHAEL RAY CANTRELL APSS, CPRS, TRADPSS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (270) 846-6335

## Contact information

- **Practice address:** 618 MCELWAIN CT, BOWLING GREEN, KY 42101-3524
- **Practice address phone:** (270) 846-6335
- **Mailing address:** 508 CLEARVIEW ST, FRANKLIN, KY 42134-2037
- **Mailing address phone:** (270) 846-6335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2021
- **Last updated:** 02/16/2021