# KIM SEGO TULLY, LCSW, PSYCHOTHERAPY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811231897
- **Authorized official:** KIMBERLY SEGO TULLY LCSW (SOLE MEMBER)
- **Authorized official phone:** (270) 307-3672

## Contact information

- **Practice address:** 240 W DIXIE AVE, SUITE 5-B, ELIZABETHTOWN, KY 42701-1586
- **Practice address phone:** (270) 307-3672
- **Mailing address:** 589 RUE LA GRANDE, ELIZABETHTOWN, KY 42701-3135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 3167 | KY | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 05/02/2017