Provider Demographics
NPI:1639435308
Name:NEWMAN, TABITHA (LPCC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials: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 411
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-0411
Mailing Address - Country:US
Mailing Address - Phone:812-518-0818
Mailing Address - Fax:
Practice Address - Street 1:1970 BARRET CT STE 123
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4944
Practice Address - Country:US
Practice Address - Phone:270-777-4490
Practice Address - Fax:866-441-1083
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY148999101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100326660Medicaid
KY12739425OtherCAQH
KY148999OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR