Healthcare Provider Details

I. General information

NPI: 1073006649
Provider Name (Legal Business Name): LINLY EVAN CALIXTE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LYDA AVE
BOWLING GREEN KY
42104-3326
US

IV. Provider business mailing address

104 REYNOLDS RD
GLASGOW KY
42141-1177
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax: 270-904-6570
Mailing address:
  • Phone: 270-904-6567
  • Fax: 270-904-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number260930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: