Healthcare Provider Details

I. General information

NPI: 1821928599
Provider Name (Legal Business Name): MARY KAITLYN DAVIS LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 HELMSDALE PL APT 4205
LEXINGTON KY
40509-2450
US

IV. Provider business mailing address

3050 HELMSDALE PL APT 4205
LEXINGTON KY
40509-2450
US

V. Phone/Fax

Practice location:
  • Phone: 502-226-0813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number295029
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: