Provider Demographics
NPI:1982755344
Name:JUDY, KATHLEEN (MS, LSW, LPCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JUDY
Suffix:
Gender:F
Credentials:MS, LSW, LPCC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:JUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC, LLC
Mailing Address - Street 1:230 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3901
Mailing Address - Country:US
Mailing Address - Phone:937-974-4951
Mailing Address - Fax:927-294-0493
Practice Address - Street 1:121 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1780
Practice Address - Country:US
Practice Address - Phone:937-974-4951
Practice Address - Fax:937-294-0493
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional