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General NPI Number Information
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NPI Number | 1285414755
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Entity Type | Organization
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Legal Business Name | E.L.Y. COUNSELING SERVICES
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 645 KNOX BLVD STE A
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City | RADCLIFF
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State | KY
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Zip | 40160-1514
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Country | US
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Telephone | 270-272-2046
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Fax |
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Provider Business Mailing Address
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Address Line | 645 KNOX BLVD STE A
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City | RADCLIFF
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State | KY
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Zip | 40160-1514
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Country | US
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Telephone | 270-272-2046
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KIMBERLY KHADOO-BAYNHAM
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Credential | M.ED., LPCC-S
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Telephone | 270-272-2046
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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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