Provider Demographics
NPI:1144606856
Name:EMBRY, JOAN ELIZABETH (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:EMBRY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:ELIZABETH
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8635
Mailing Address - Country:US
Mailing Address - Phone:270-315-8835
Mailing Address - Fax:
Practice Address - Street 1:1269 DUVALL RD
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8637
Practice Address - Country:US
Practice Address - Phone:270-274-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00221274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional