Healthcare Provider Details

I. General information

NPI: 1326219544
Provider Name (Legal Business Name): JALANE SPEAKS NCC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2008
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BEITING LN
MOUNT VERNON KY
40456-6376
US

IV. Provider business mailing address

278 BEITING LN
MOUNT VERNON KY
40456-6376
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-5623
  • Fax: 606-256-5622
Mailing address:
  • Phone: 606-256-5623
  • Fax: 606-256-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104817
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: