Healthcare Provider Details

I. General information

NPI: 1437589611
Provider Name (Legal Business Name): DERRICK TRAMMELL LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 BANKLICK ST
COVINGTON KY
41011-3029
US

IV. Provider business mailing address

9599 SUMMER HILL RD
CALIFORNIA KY
41007-9055
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-8500
  • Fax:
Mailing address:
  • Phone: 859-635-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number162781
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: