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General NPI Number Information
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NPI Number | 1174275366
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Entity Type | Individual
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Provider Name | JUSTIN AMOND LINCEY
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Gender | Male
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 406 BLANKENBAKER PKWY
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City | MIDDLETOWN
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State | KY
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Zip | 40243-1881
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Country | US
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Telephone | 229-789-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 5407 WINTERGREEN RD
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City | LOUISVILLE
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State | KY
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Zip | 40272-3413
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Country | US
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Telephone | 229-789-8880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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