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General NPI Number Information
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NPI Number | 1790385151
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Entity Type | Individual
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Provider Name | AMY LEE CONLEY TCADC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 607 CLIFTY ST
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City | SOMERSET
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State | KY
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Zip | 42503-1765
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Country | US
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Telephone | 606-485-4730
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Fax | 606-485-4733
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Provider Business Mailing Address
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Address Line | 5210 HIGHWAY 196
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City | NANCY
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State | KY
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Zip | 42544-6502
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Country | US
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Telephone | 606-923-5679
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Fax | 606-485-4733
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 245017
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License Number State | KY
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