Provider Demographics
NPI:1689101925
Name:TAYLOR-EDGE, STEPHANIE K (LPCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:TAYLOR-EDGE
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 1:338 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7949
Mailing Address - Country:US
Mailing Address - Phone:270-313-9898
Mailing Address - Fax:
Practice Address - Street 1:920 FREDERICA ST STE 407
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3079
Practice Address - Country:US
Practice Address - Phone:270-689-0073
Practice Address - Fax:270-689-0083
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY05Medicaid