Provider Demographics
NPI:1073724100
Name:CLAGETT, JOAN LESLIE (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LESLIE
Last Name:CLAGETT
Suffix:
Gender:F
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 WESTPORT RD STE B
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2950
Mailing Address - Country:US
Mailing Address - Phone:270-769-2253
Mailing Address - Fax:270-769-0170
Practice Address - Street 1:551 WESTPORT RD STE B
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2950
Practice Address - Country:US
Practice Address - Phone:270-769-2253
Practice Address - Fax:270-769-0170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0036101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral