MEDICARE: MR. RALPH A. DENNISON LPCC

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	KY-1207	KY

General Provider Information

NPI Number	:	1225376171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH A. DENNISON LPCC

Provider Business Mailing Address
First Line	:	3044 BARDSTOWN RD
Second Line	:	#137
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3020
Country	:	US
Telephone Number	:	502-797-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 LILY CREEK RD
Second Line	:	SUITE 201
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2816
Country	:	US
Telephone Number	:	502-554-7591
Fax Number	:

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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