Provider Demographics
NPI:1225138449
Name:WEBB, ELIZABETH BOURNE (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BOURNE
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-0246
Mailing Address - Country:US
Mailing Address - Phone:270-825-8746
Mailing Address - Fax:270-825-8746
Practice Address - Street 1:4915 HANSON ROAD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-825-8746
Practice Address - Fax:270-825-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLCSW 18201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0273Medicaid
KYCSW0273Medicaid