Healthcare Provider Details

I. General information

NPI: 1942673066
Provider Name (Legal Business Name): JESSICA COY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MOORMAN LPCC

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 FREDERICA ST
OWENSBORO KY
42301-5442
US

IV. Provider business mailing address

2720 FREDERICA ST
OWENSBORO KY
42301-5442
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2484
  • Fax: 270-685-6015
Mailing address:
  • Phone: 270-926-2484
  • Fax: 270-685-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCCA00218277
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: