Provider Demographics
NPI:1184218778
Name:JEFFCOAT, KATIE DANIELLE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:DANIELLE
Last Name:JEFFCOAT
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 1:998 BROOKS INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8154
Mailing Address - Country:US
Mailing Address - Phone:502-487-1833
Mailing Address - Fax:
Practice Address - Street 1:3512 TIMMONS CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-8528
Practice Address - Country:US
Practice Address - Phone:502-487-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional