Healthcare Provider Details

I. General information

NPI: 1225435332
Provider Name (Legal Business Name): MARIETTA JUSTICE MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIETTA STRAUSBAUGH

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ARTILLERY PARK DR UNIT 201
FORT MITCHELL KY
41017-2798
US

IV. Provider business mailing address

309 ARTILLERY PARK DR UNIT 201
FORT MITCHELL KY
41017-2798
US

V. Phone/Fax

Practice location:
  • Phone: 859-414-6471
  • Fax:
Mailing address:
  • Phone: 859-414-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number261755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: