Provider Demographics
NPI:1952041436
Name:BEDTELYON, LISA (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BEDTELYON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FRANKS RD
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:41348-9084
Mailing Address - Country:US
Mailing Address - Phone:859-536-9367
Mailing Address - Fax:
Practice Address - Street 1:54 FRANKS RD
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:KY
Practice Address - Zip Code:41348-9084
Practice Address - Country:US
Practice Address - Phone:859-536-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist