Healthcare Provider Details

I. General information

NPI: 1023359320
Provider Name (Legal Business Name): MATTHEW DAVID MOUNTJOY LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 CUMBERLAND FALLS HWY STE B201
CORBIN KY
40701-2793
US

IV. Provider business mailing address

1019 CUMBERLAND FALLS HWY STE B201
CORBIN KY
40701-2793
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax:
Mailing address:
  • Phone: 606-528-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number294900
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: