Provider Demographics
NPI:1447517800
Name:PUGH, LEAH (LPCC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:HEDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:219 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1105
Mailing Address - Country:US
Mailing Address - Phone:606-375-5913
Mailing Address - Fax:
Practice Address - Street 1:219 MILLS AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1105
Practice Address - Country:US
Practice Address - Phone:606-375-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30608012Medicaid