Doctor Name: | LEANN DETHERAGE |
NPI Number: | 1477886380 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCA |
License Number: | KY-0911 |
Business Practice Address: | 3244 Wimsatt Road Loretto, KY - 40037 |
Business Phone Number: | 2706991811 |
Business Fax Number: | |
Mailing Address: | Po Box 105, LORETTO |
State: | KY |
Postal Code: | 400370105 |
Phone Number: | 2706991811 |
Fax Number: | |
NPI Enumeration Date: | 09/09/2009 |
NPI Last Update Date: | 12/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | KY-0911 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |