Healthcare Provider Details

I. General information

NPI: 1649681859
Provider Name (Legal Business Name): KIMBERLY MOYNAHAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DANVILLE LOOP 1 RD
NICHOLASVILLE KY
40356-8680
US

IV. Provider business mailing address

122 DANVILLE LOOP 1 RD
NICHOLASVILLE KY
40356-8680
US

V. Phone/Fax

Practice location:
  • Phone: 859-881-5010
  • Fax:
Mailing address:
  • Phone: 859-881-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number245613
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: