Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Kevin R Blalock, LCSW, JSOCCP

Individual provider Clinical Social Worker · NPI 1780573477

Mr. Kevin R Blalock, LCSW, JSOCCP is a Clinical Social Worker in Bowling Green, Kentucky. Qualified in 2017, 9 years ago. Practices as a sole proprietor. Licensed in Kentucky.

Years since qualifying
9
Licensed in
KY
In the registry since
2025
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3484 Glen Lily Rd
Bowling Green, KY 42101-7849
Phone: (334) 441-6165
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 258181 (KY)

Record details

NPI number1780573477
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW , JSOCCP
Sole proprietorYes
NPI enumeratedJune 30, 2025
Last updated in NPPESJune 30, 2025
Certification dateJune 30, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated

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