Basic Information
| Provider Information | |||||||||
| NPI: | 1891137717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYTON | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | ALEECE GIBSON | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 DREXLER CIR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427017843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707952605 | ||||||||
| FaxNumber: | 2702348572 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427012621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707691304 | ||||||||
| FaxNumber: | 2702348028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 07/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 168175 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.