Provider Demographics
NPI:1710624820
Name:SALYERS, JIMMY DEAN JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DEAN
Last Name:SALYERS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0542
Mailing Address - Country:US
Mailing Address - Phone:606-372-6020
Mailing Address - Fax:
Practice Address - Street 1:1841 PEARTREE LN
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4460
Practice Address - Country:US
Practice Address - Phone:270-569-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2585491041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100821660Medicaid
KY258549OtherBOARD OF SOCIAL WORK KY