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General NPI Number Information
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NPI Number | 1104805365
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Entity Type | Organization
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Legal Business Name | CRAIG CONGLETON LCSW
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Dates
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Enumeration Date | 01/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1105 S LIMESTONE
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City | LEXINGTON
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State | KY
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Zip | 40503-1057
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Country | US
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Telephone | 859-254-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 125 KENTUCKY AVE
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City | LEXINGTON
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State | KY
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Zip | 40502-1718
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Country | US
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Telephone | 859-254-8185
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG BREWER CONGLETON
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Credential | LCSW
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Telephone | 859-254-8185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0725
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License Number State | KY
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