Healthcare Provider Details

I. General information

NPI: 1659424141
Provider Name (Legal Business Name): GWEN MCGLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PROFESSIONAL PARK DR
LOUISA KY
41230
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4332
  • Fax: 606-638-4394
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: