Healthcare Provider Details

I. General information

NPI: 1235868464
Provider Name (Legal Business Name): BRAIDEN LYNN ABBOTT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 DESTINY LN STE 112
BOWLING GREEN KY
42104-1089
US

IV. Provider business mailing address

1830 DESTINY LN STE 112
BOWLING GREEN KY
42104-1089
US

V. Phone/Fax

Practice location:
  • Phone: 615-681-6885
  • Fax:
Mailing address:
  • Phone: 615-681-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number305572
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: