Provider Demographics
NPI:1245536812
Name:GREENWELL, KARON MAY (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:KARON
Middle Name:MAY
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 VEACH RD
Mailing Address - Street 2:SUITE# 208
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6295
Mailing Address - Country:US
Mailing Address - Phone:270-240-5086
Mailing Address - Fax:270-228-0341
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:SUITE# 208
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-240-5086
Practice Address - Fax:270-228-0341
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-12661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100274130Medicaid
KYK085101Medicare PIN