Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
Y | 101YP2500X | Professional Counselor | KY |
NPI | 1003567660 |
---|---|
Provider Name | Bethany Mae Killian |
First Address | Radcliff, KY 40160-1253 |
Second Address | Radcliff, KY 40160-1253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |