Provider Demographics
NPI:1417313131
Name:GILLESPIE, JEANETTA (LPCA)
Entity Type:Individual
Prefix:
First Name:JEANETTA
Middle Name:
Last Name:GILLESPIE
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 1:1079 THORNBERRY DR
Mailing Address - Street 2:D
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1600
Mailing Address - Country:US
Mailing Address - Phone:270-874-2560
Mailing Address - Fax:270-825-8081
Practice Address - Street 1:1079 THORNBERRY DR
Practice Address - Street 2:D
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1600
Practice Address - Country:US
Practice Address - Phone:270-874-2560
Practice Address - Fax:270-825-8081
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00222146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health