Provider Demographics
NPI:1245392240
Name:WHITSON, KATHY GLYN (LPCC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:GLYN
Last Name:WHITSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3018
Mailing Address - Country:US
Mailing Address - Phone:270-997-0262
Mailing Address - Fax:270-735-9848
Practice Address - Street 1:4000 N DIXIE HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4649
Practice Address - Country:US
Practice Address - Phone:270-997-0262
Practice Address - Fax:270-735-9848
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid