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General NPI Number Information
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NPI Number | 1538977624
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Entity Type | Individual
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Provider Name | KAILEE BROOKE WOOTON LPCA
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Gender | Female
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1480 W CUMBERLAND GAP PKWY
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City | CORBIN
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State | KY
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Zip | 40701-5902
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Country | US
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Telephone | 606-393-6695
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Fax |
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Provider Business Mailing Address
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Address Line | 421 CHOP BOTTOM RD
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City | MANCHESTER
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State | KY
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Zip | 40962-8912
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Country | US
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Telephone | 606-594-1573
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 291024
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 291024
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License Number State | KY
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