Healthcare Provider Details

I. General information

NPI: 1306752332
Provider Name (Legal Business Name): SUE ELLEN REIMONDO PH.D., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SAGE GRASS DR
BEREA KY
40403-1399
US

IV. Provider business mailing address

402 SAGE GRASS DR
BEREA KY
40403-1399
US

V. Phone/Fax

Practice location:
  • Phone: 859-314-1493
  • Fax:
Mailing address:
  • Phone: 502-694-9488
  • Fax: 502-276-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105684
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: