Healthcare Provider Details

I. General information

NPI: 1467964486
Provider Name (Legal Business Name): LEILA M GOODPASTER LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 ELK LAKE CT.
LEXINGTON KY
40517
US

IV. Provider business mailing address

4835 POPLAR LEVEL RD STE 110
LOUISVILLE KY
40213-2906
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-2657
  • Fax:
Mailing address:
  • Phone: 855-591-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number174455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: