Provider Demographics
NPI:1285134692
Name:LEWIS, KATHY RENAE (LPCC-S)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:RENAE
Last Name:LEWIS
Suffix:
Gender:
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 INDIAN MOUND DR STE D
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1300
Mailing Address - Country:US
Mailing Address - Phone:859-404-6074
Mailing Address - Fax:
Practice Address - Street 1:1107 INDIAN MOUND DR STE D
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1300
Practice Address - Country:US
Practice Address - Phone:859-404-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid