Healthcare Provider Details

I. General information

NPI: 1548445901
Provider Name (Legal Business Name): SUSAN D MINGS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN D SHOFNER LCSW

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PHILLIPS LN STE 2
HODGENVILLE KY
42748-1654
US

IV. Provider business mailing address

107 CRANES ROOST CT
ELIZABETHTOWN KY
42701-3650
US

V. Phone/Fax

Practice location:
  • Phone: 270-358-5667
  • Fax: 270-358-0241
Mailing address:
  • Phone: 270-765-2605
  • Fax: 270-234-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: