Provider Demographics
NPI:1902235575
Name:KHADOO-BAYNHAM, KIMBERLY (LPCC-S)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KHADOO-BAYNHAM
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KHADOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:100 AZALEA PARK TRL APT 8
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-3900
Mailing Address - Country:US
Mailing Address - Phone:270-272-2046
Mailing Address - Fax:
Practice Address - Street 1:201 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1086
Practice Address - Country:US
Practice Address - Phone:859-271-9448
Practice Address - Fax:270-858-4029
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243316101YM0800X, 101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid
KY7100592990Medicaid