Organization
SPECIALISTSMAT PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARA NICOLE NETHERTON (PRACTICE MANAGER)
(502) 212-0071
Entity
Organization
Contact information
Practice address
110 CHASE WAY STE 2, ELIZABETHTOWN, KY 42701-7827
(502) 212-0071
(502) 530-5303
Mailing address
110 CHASE WAY STE 2, ELIZABETHTOWN, KY 42701-7827
(502) 212-0071
(502) 996-8359
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103T00000X
Psychologist
—
—
207LA0401X
Addiction Medicine (Anesthesiology) Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
10/09/2020
Last updated
11/17/2025
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