Healthcare Provider Details

I. General information

NPI: 1205496825
Provider Name (Legal Business Name): HOLLY NICOLE LOCKHART-KIDD M.ED, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 FARM RIDGE RD
STEARNS KY
42647-6171
US

IV. Provider business mailing address

401 BOGLE ST STE 201
SOMERSET KY
42503-2850
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-8111
  • Fax:
Mailing address:
  • Phone: 606-516-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number248146
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: