Healthcare Provider Details

I. General information

NPI: 1154215481
Provider Name (Legal Business Name): ABIGAIL CHANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 SLATE AVE
OWINGSVILLE KY
40360-2206
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 866-233-2955
  • Fax:
Mailing address:
  • Phone: 606-329-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number304492
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: