| Kim Sego Tully, Lcsw, Psychotherapy Services | |
|
240 W Dixie Ave Suite 5-b Elizabethtown KY 42701-1586 | |
| (270) 307-3672 | |
| Not Available |
| Full Name | Kim Sego Tully, Lcsw, Psychotherapy Services |
|---|---|
| Speciality | Social Worker |
| Location | 240 W Dixie Ave, Elizabethtown, Kentucky |
| Authorized Official Name and Position | Kimberly Sego Tully (SOLE MEMBER) |
| Authorized Official Contact | 2703073672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Sego Tully, Lcsw, Psychotherapy Services 589 Rue La Grande Elizabethtown KY 42701-3135 Ph: () - | Kim Sego Tully, Lcsw, Psychotherapy Services 240 W Dixie Ave Suite 5-b Elizabethtown KY 42701-1586 Ph: (270) 307-3672 |
| NPI Number | 1811231897 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 05/02/2017 |
| Medicare PECOS PAC ID | 7911150313 |
|---|---|
| Medicare Enrollment ID | O20130115000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811231897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 3167 (Kentucky) | Primary |
| Provider Name | Kimberly D Becker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760420459 PECOS PAC ID: 1759469620 Enrollment ID: I20080417000053 |
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