Provider Demographics
NPI:1376958314
Name:LIGHTNER, KELLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ORPHANAGE RD.
Mailing Address - Street 2:
Mailing Address - City:FT. MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-0007
Mailing Address - Country:US
Mailing Address - Phone:859-331-0821
Mailing Address - Fax:859-331-1614
Practice Address - Street 1:75 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3006
Practice Address - Country:US
Practice Address - Phone:859-331-0821
Practice Address - Fax:859-331-1614
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical