Provider Demographics
NPI:1134512775
Name:FENTRESS, LINDA EVELYN (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:EVELYN
Last Name:FENTRESS
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 PERIMETER DR STE 115
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4351
Mailing Address - Country:US
Mailing Address - Phone:573-355-0301
Mailing Address - Fax:859-305-5083
Practice Address - Street 1:651 PERIMETER DR STE 115
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4351
Practice Address - Country:US
Practice Address - Phone:859-721-3259
Practice Address - Fax:859-305-5083
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013014933101YP2500X
KY168174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100409410Medicaid