Bacon, Christina G

Bacon, Christina G is an individual health care provider with primary practice located at 292 Glades Rd Ste 8 , Berea KY 40403. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Counseling. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Bacon, Christina G can be contacted via phone (859) 985-7862.

Contact Information

Primary practice address
292 Glades Rd Ste 8 Berea KY 40403
Phone: (859) 985-7862
Fax: (859) 972-0616
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 137685 Kentucky
Behavioral Health & Social Service Providers / Counseling 103TC1900X 247601 Kentucky
Behavioral Health & Social Service Providers / Psychologist 103T00000X 247601 Kentucky

Profile Details

NPI number 1487704649
LBN Legal business name Bacon, Christina G
Credentials MS, LPP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Sep 9th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487704649 NPPES
Kentucky MEDICAID 7100610370

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