Healthcare Provider Details

I. General information

NPI: 1821588658
Provider Name (Legal Business Name): EMILEE CLINE LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD STE 2
BOWLING GREEN KY
42104-7908
US

IV. Provider business mailing address

5966 SCOTTSVILLE RD STE 2
BOWLING GREEN KY
42104-7908
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number262900
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number262900
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: