Provider Demographics
NPI:1871950196
Name:DYCUS, KELLY L (LPCC-S)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:DYCUS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5097 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8694
Mailing Address - Country:US
Mailing Address - Phone:502-545-3769
Mailing Address - Fax:
Practice Address - Street 1:627 COMANCHE TRL STE 3
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1753
Practice Address - Country:US
Practice Address - Phone:502-545-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-16
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY1445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health