Healthcare Provider Details

I. General information

NPI: 1326367467
Provider Name (Legal Business Name): MARY LYNN PHILBECK M.ED., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LOVELL CT
MOUNT VERNON KY
40456-2964
US

IV. Provider business mailing address

26 HONEYSUCKLE LN
MOUNT VERNON KY
40456-6746
US

V. Phone/Fax

Practice location:
  • Phone: 606-392-2060
  • Fax:
Mailing address:
  • Phone: 606-386-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104205
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: