Provider Demographics
NPI:1417594482
Name:RECORD, KEVIN B (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:B
Last Name:RECORD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-658-6113
Mailing Address - Fax:731-658-1597
Practice Address - Street 1:844 NATCHEZ TRACE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351
Practice Address - Country:US
Practice Address - Phone:731-967-8803
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional