Healthcare Provider Details

I. General information

NPI: 1053058321
Provider Name (Legal Business Name): BETHSHEBA ALEXANDER NIETO LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N MAIN ST STE 240
HAZARD KY
41701-2503
US

IV. Provider business mailing address

16 OAK LN
LILY KY
40740-3388
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2662
  • Fax:
Mailing address:
  • Phone: 606-231-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number283490
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: