Provider Demographics
NPI:1316821150
Name:BLACK COTTON THERAPY SERVICES OF KENTUCKY LLC
Entity type:Organization
Organization Name:BLACK COTTON THERAPY SERVICES OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-987-8369
Mailing Address - Street 1:741 PIEDMONT AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1420
Mailing Address - Country:US
Mailing Address - Phone:404-987-8369
Mailing Address - Fax:
Practice Address - Street 1:212 N 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1408
Practice Address - Country:US
Practice Address - Phone:509-768-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK COTTON THERAPY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health