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General NPI Number Information
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NPI Number | 1497809008
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Entity Type | Individual
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Provider Name | DEBORAH KAY CHAMPION M.A., LPCC,
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 1711 DESTINY LN STE. 111
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1066
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Country | US
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Telephone | 270-846-3853
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Fax | 270-846-3857
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Provider Business Mailing Address
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Address Line | PO BOX 156 1711 DESTINY LANE, STE. 111
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City | BOWLING GREEN
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State | KY
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Zip | 42102-0156
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Country | US
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Telephone | 270-846-3853
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Fax | 270-846-3857
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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 | KY-0022
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License Number State | KY
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