| Organization Name: | ML CANTRELL PSYCHOTHERAPEUTIC SERVICES, PLLC |
| NPI Number: | 1467851667 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY LOU CANTRELL (SOLE OWNER) |
| Mailing Address: | 1219 W Main St West Liberty |
| State: | KY US |
| Postal Code: | 414722161 |
| Phone Number: | 6067432407 |
| Fax Number: | |
| NPI Enumeration Date: | 08/14/2014 |
| NPI Last Update Date: | 08/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSYPPR00193411 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |