1245392240 NPI number — KATHY GLYN WHITSON LPCC

Table of content: KATHY GLYN WHITSON LPCC (NPI 1245392240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245392240 NPI number — KATHY GLYN WHITSON LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITSON
Provider First Name:
KATHY
Provider Middle Name:
GLYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245392240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 GOODMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASGOW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42141-3018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-997-0262
Provider Business Mailing Address Fax Number:
270-735-9848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 N DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-997-0262
Provider Business Practice Location Address Fax Number:
270-735-9848
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30604011 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com