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Individual

MRS. LEE MEGAN MATTINGLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
1311 N DIXIE AVE BLDG C, ELIZABETHTOWN, KY 42701-2621
(270) 692-1304
(270) 234-8028
Mailing address
1311 N DIXIE AVE BLDG C, ELIZABETHTOWN, KY 42701-2621
(270) 692-1304
(270) 234-8028

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
0978
103TC0700X
Clinical Psychologist
Primary
170692
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790731081
KY
Enumeration date
06/20/2008
Last updated
09/26/2022
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