Healthcare Provider Details

I. General information

NPI: 1205282829
Provider Name (Legal Business Name): TONY S JEWELL LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 INGRAM AVENUE
CAMPBELLSVILLE KY
42718-1621
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number105388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: