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204 Bevins Ln Ste A Georgetown KY 40324-6145 | |
| (859) 951-9777 | |
| (859) 951-9779 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 204 Bevins Ln Ste A, Georgetown, Kentucky |
| Authorized Official Name and Position | Lesa Young (OWNER) |
| Authorized Official Contact | 5027350227 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
204 Bevins Ln Ste A Georgetown KY 40324-6145 Ph: (859) 951-9777 | 204 Bevins Ln Ste A Georgetown KY 40324-6145 Ph: (859) 951-9777 |
| NPI Number | 1750854170 |
|---|---|
| Provider Enumeration Date | 01/08/2019 |
| Last Update Date | 07/13/2020 |
| Certification Date | 07/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750854170 | NPI | - | NPPES |
| 7100583370 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
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