Healthcare Provider Details

I. General information

NPI: 1811433659
Provider Name (Legal Business Name): MICHAEL GEORGE MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 DOCTORS DR
FRANKFORT KY
40601-4101
US

IV. Provider business mailing address

191 DOCTORS DR
FRANKFORT KY
40601-4101
US

V. Phone/Fax

Practice location:
  • Phone: 502-223-2182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: