Individual
SHEVAN THREATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2250 THUNDERSTICK DR STE 1104, LEXINGTON, KY 40505-9009
(859) 254-1035
Mailing address
2250 THUNDERSTICK DR STE 1104, LEXINGTON, KY 40505-9009
(859) 254-1035
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3556
KY
1041C0700X
Clinical Social Worker
Primary
3556
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100284370
—
KY
Enumeration date
08/09/2011
Last updated
07/21/2022
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