Provider Demographics
NPI:1417647520
Name:SAMUEL, JANE DURKIN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:DURKIN
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 RIDGECANE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1123
Mailing Address - Country:US
Mailing Address - Phone:859-230-0856
Mailing Address - Fax:
Practice Address - Street 1:620 EUCLID AVE STE 203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6429
Practice Address - Country:US
Practice Address - Phone:859-687-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY284119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist