MEDICARE: JOSEPH BENJAMIN AUTRY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	307017	KY
2	101YM0800X	Mental Health Counselor	0701010290	VA

General Provider Information

NPI Number	:	1205414927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BENJAMIN AUTRY LPC

Provider Business Mailing Address
First Line	:	4030 TATES CREEK RD APT 1210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3087
Country	:	US
Telephone Number	:	571-438-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 TATES CREEK RD APT 1210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3087
Country	:	US
Telephone Number	:	571-438-7508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/09/2026

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