Healthcare Provider Details

I. General information

NPI: 1285414755
Provider Name (Legal Business Name): E.L.Y. COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 KNOX BLVD STE A
RADCLIFF KY
40160-1514
US

IV. Provider business mailing address

645 KNOX BLVD STE A
RADCLIFF KY
40160-1514
US

V. Phone/Fax

Practice location:
  • Phone: 270-272-2046
  • Fax:
Mailing address:
  • Phone: 270-272-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY KHADOO-BAYNHAM
Title or Position: OWNER/THERAPIST
Credential: M.ED., LPCC-S
Phone: 270-272-2046