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General NPI Number Information
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NPI Number | 1750786885
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Entity Type | Individual
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Provider Name | LISA CAROL CLEM LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 236 BRIDGETT DR
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City | MT STERLING
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State | KY
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Zip | 40353-1601
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Country | US
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Telephone | 859-498-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 LITTLE HARDWICKS CREEK RD
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City | CLAY CITY
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State | KY
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Zip | 40312-9652
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Country | US
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Telephone | 859-230-5957
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 61-0723605
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License Number State | KY
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