MEDICARE: KATELYN ARVIN 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	1041C0700X	Clinical Social Worker	247025	KY

General Provider Information

NPI Number	:	1710519533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ARVIN LPCC

Provider Business Mailing Address
First Line	:	5200 COMMERCE CROSSINGS DR FL 3
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-2182
Country	:	US
Telephone Number	:	502-253-4966
Fax Number	:	502-487-5751

Provider Business Practice Location Address
First Line	:	789 EASTERN BYP STE 23
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2421
Country	:	US
Telephone Number	:	859-544-8171
Fax Number	:	859-544-8197

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	12/09/2020

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