Individual
MRS. CHRISTINA G BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPP
Contact information
Practice address
292 GLADES RD STE 8, BEREA, KY 40403
(859) 985-7862
(859) 972-0616
Mailing address
212 OAK BRANCH DR, BEREA, KY 40403-9581
(859) 302-1768
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
137685
KY
103T00000X
Psychologist
Primary
247601
KY
103TC1900X
Counseling Psychologist
247601
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100610370
—
KY
Enumeration date
01/11/2007
Last updated
09/09/2019
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