Provider Demographics
NPI:1396316238
Name:VANDEVENTER, LYNNSEY KAITLIN (LPCC, NCC)
Entity type:Individual
Prefix:
First Name:LYNNSEY
Middle Name:KAITLIN
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 NATURES WAY
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9434
Mailing Address - Country:US
Mailing Address - Phone:270-250-0927
Mailing Address - Fax:
Practice Address - Street 1:2048 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILLISBURG
Practice Address - State:KY
Practice Address - Zip Code:40078
Practice Address - Country:US
Practice Address - Phone:270-250-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional