Provider Demographics
NPI:1053649988
Name:PROUTY, JANE (LMFT, LPCC, CADC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:PROUTY
Suffix:
Gender:F
Credentials:LMFT, LPCC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2423
Mailing Address - Country:US
Mailing Address - Phone:270-763-0728
Mailing Address - Fax:270-763-0618
Practice Address - Street 1:110 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2423
Practice Address - Country:US
Practice Address - Phone:270-763-0728
Practice Address - Fax:270-763-0618
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105803101YP2500X
KY106480106H00000X
KY166848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)