Provider Demographics
NPI:1619560414
Name:KISHBAUGH, PATRICIA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
Last Name:KISHBAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 MUD RIVER UNION RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:KY
Mailing Address - Zip Code:42324-3331
Mailing Address - Country:US
Mailing Address - Phone:270-820-5065
Mailing Address - Fax:
Practice Address - Street 1:1937 MUD RIVER UNION RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:KY
Practice Address - Zip Code:42324-3331
Practice Address - Country:US
Practice Address - Phone:270-820-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2588251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical