Healthcare Provider Details

I. General information

NPI: 1538071105
Provider Name (Legal Business Name): STEPHEN LEMON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 JARVIS AVE
SOMERSET KY
42501-1855
US

IV. Provider business mailing address

402 JARVIS AVE
SOMERSET KY
42501-1855
US

V. Phone/Fax

Practice location:
  • Phone: 606-465-2713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number304022
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: