Provider Demographics
NPI:1902119167
Name:JARNAGIN, MARY PATRICIA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:JARNAGIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CUSTER DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4010
Mailing Address - Country:US
Mailing Address - Phone:859-227-9266
Mailing Address - Fax:502-406-5803
Practice Address - Street 1:3150 CUSTER DR STE 203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4010
Practice Address - Country:US
Practice Address - Phone:859-227-9266
Practice Address - Fax:502-406-5803
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1120101YP2500X
KY0738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100278580Medicaid