Healthcare Provider Details

I. General information

NPI: 1144378225
Provider Name (Legal Business Name): KELLY J CLASGENS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 LICKING PIKE
WILDER KY
41071
US

IV. Provider business mailing address

519 LICKING PIKE
WILDER KY
41071
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-0400
  • Fax: 859-442-3363
Mailing address:
  • Phone: 859-572-0400
  • Fax: 859-442-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0416
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: