Provider Demographics
NPI:1942666094
Name:HARLEY, AUDRA J (LPCC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:J
Last Name:HARLEY
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 1:100 W 3RD ST STE 304
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4129
Mailing Address - Country:US
Mailing Address - Phone:270-925-8958
Mailing Address - Fax:270-698-9778
Practice Address - Street 1:100 W 3RD ST STE 304
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4129
Practice Address - Country:US
Practice Address - Phone:270-925-8958
Practice Address - Fax:270-698-9778
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164690101YP2500X
KY242158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional