Provider Demographics
NPI:1912739087
Name:MOBERLY, MADISON HARNED (LPCC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:HARNED
Last Name:MOBERLY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DIAGNOSTIC DR STE B
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6559
Mailing Address - Country:US
Mailing Address - Phone:502-352-2208
Mailing Address - Fax:
Practice Address - Street 1:105 DIAGNOSTIC DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6559
Practice Address - Country:US
Practice Address - Phone:502-352-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY293632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional