Healthcare Provider Details

I. General information

NPI: 1891137717
Provider Name (Legal Business Name): BETHANY ALEECE GIBSON PAYTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N DIXIE HWY
ELIZABETHTOWN KY
42701-2621
US

IV. Provider business mailing address

151 DREXLER CIR STE 1
ELIZABETHTOWN KY
42701-7843
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-1304
  • Fax: 270-234-8028
Mailing address:
  • Phone: 270-795-2605
  • Fax: 270-234-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number168175
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: