Healthcare Provider Details

I. General information

NPI: 1528566114
Provider Name (Legal Business Name): ALTERI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W LOWRY LN STE 200
LEXINGTON KY
40503-3025
US

IV. Provider business mailing address

190 W LOWRY LN STE 200
LEXINGTON KY
40503-3025
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-4992
  • Fax:
Mailing address:
  • Phone: 859-277-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN D SMITH
Title or Position: OWNER
Credential:
Phone: 859-276-1015