Provider Demographics
NPI:1093583577
Name:RANDALL, EMILY CLAY (LPCA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAY
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 BAY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1020
Mailing Address - Country:US
Mailing Address - Phone:859-421-2249
Mailing Address - Fax:
Practice Address - Street 1:2401 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3106
Practice Address - Country:US
Practice Address - Phone:502-519-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY286651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health