Provider Demographics
NPI:1497809008
Name:CHAMPION, DEBORAH KAY (MA, LPCC,)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MA, LPCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:1711 DESTINY LANE, STE. 111
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-0156
Mailing Address - Country:US
Mailing Address - Phone:270-846-3853
Mailing Address - Fax:270-846-3857
Practice Address - Street 1:1711 DESTINY LN
Practice Address - Street 2:STE. 111
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1066
Practice Address - Country:US
Practice Address - Phone:270-846-3853
Practice Address - Fax:270-846-3857
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional