Healthcare Provider Details

I. General information

NPI: 1063127223
Provider Name (Legal Business Name): EMILY MANNING LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 DARBY CREEK RD STE C
LEXINGTON KY
40509-1603
US

IV. Provider business mailing address

175 SWILCAN BRIDGE WAY
GEORGETOWN KY
40324-6908
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-2567
  • Fax: 859-788-3905
Mailing address:
  • Phone: 606-219-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number282880
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: