Healthcare Provider Details

I. General information

NPI: 1356701353
Provider Name (Legal Business Name): EMILY J KLINGENSMITH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 08/12/2024
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JONES PARK ELEMENTARY HEALTHY KIDS CLINIC 6295 E KY 70
LIBERTY KY
42539
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax:
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCCA00225150
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number248597
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: