Healthcare Provider Details

I. General information

NPI: 1366929374
Provider Name (Legal Business Name): ALFONSO ISRAEL EL LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 OLD LAGRANGE RD
BUCKNER KY
40010-9547
US

IV. Provider business mailing address

2114 AIKEN BACK LN
LA GRANGE KY
40031-6969
US

V. Phone/Fax

Practice location:
  • Phone: 502-602-0074
  • Fax:
Mailing address:
  • Phone: 502-224-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number263200
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20598
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: