Healthcare Provider Details

I. General information

NPI: 1467365452
Provider Name (Legal Business Name): CARLEEN KIDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 PUBLIC SQ
ELIZABETHTOWN KY
42701-1457
US

IV. Provider business mailing address

218 OLD BELMONT RD
LEBANON JUNCTION KY
40150-8029
US

V. Phone/Fax

Practice location:
  • Phone: 270-401-1796
  • Fax:
Mailing address:
  • Phone: 270-401-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: