Provider Demographics
NPI:1710355953
Name:MABRY, GENEVA (LPCA)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 SALYERS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:KY
Mailing Address - Zip Code:41171-7398
Mailing Address - Country:US
Mailing Address - Phone:606-738-6368
Mailing Address - Fax:
Practice Address - Street 1:587 SALYERS BRANCH RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-7398
Practice Address - Country:US
Practice Address - Phone:606-738-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00220342101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor