Individual
JUSTIN DEREK CONN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1351 NEWTOWN PIKE BLDG 1, LEXINGTON, KY 40511
(859) 253-1686
Mailing address
1351 NEWTOWN PIKE BLDG 1, LEXINGTON, KY 40511-1277
(859) 253-1686
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
05/13/2014
Last updated
08/28/2018
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