Individual
JOHN W BLACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPA
Contact information
Practice address
110 ROACH ST, GEORGETOWN, KY 40324-9393
(859) 253-1686
(859) 254-2743
Mailing address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1217
(859) 253-1686
(859) 254-2743
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
241827
KY
103T00000X
Psychologist
Primary
423
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
01/10/2007
Last updated
07/22/2026
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