Healthcare Provider Details

I. General information

NPI: 1164114708
Provider Name (Legal Business Name): EMILY BRUNSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1505
US

IV. Provider business mailing address

503 FARRELL DR
COVINGTON KY
41011-3775
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-3200
  • Fax:
Mailing address:
  • Phone: 859-578-3200
  • Fax: 859-534-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number285397
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: