Provider Demographics
NPI:1285414755
Name:E.L.Y. COUNSELING SERVICES
Entity type:Organization
Organization Name:E.L.Y. COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADOO-BAYNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC-S
Authorized Official - Phone:270-272-2046
Mailing Address - Street 1:645 KNOX BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1514
Mailing Address - Country:US
Mailing Address - Phone:270-272-2046
Mailing Address - Fax:
Practice Address - Street 1:645 KNOX BLVD STE A
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1514
Practice Address - Country:US
Practice Address - Phone:270-272-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty