Provider Demographics
NPI:1538977624
Name:WOOTON, KAILEE BROOKE (LPCA)
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:BROOKE
Last Name:WOOTON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:KAILEE
Other - Middle Name:BROOKE
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:421 CHOP BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8912
Mailing Address - Country:US
Mailing Address - Phone:606-594-1573
Mailing Address - Fax:
Practice Address - Street 1:1480 W CUMBERLAND GAP PKWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-5902
Practice Address - Country:US
Practice Address - Phone:606-393-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-21
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291024101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor