Provider Demographics
NPI:1750786885
Name:CLEM, LISA CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:CLEM
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 1:1665 LITTLE HARDWICKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-9652
Mailing Address - Country:US
Mailing Address - Phone:859-230-5957
Mailing Address - Fax:
Practice Address - Street 1:236 BRIDGETT DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1601
Practice Address - Country:US
Practice Address - Phone:859-498-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61-0723605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid