Healthcare Provider Details

I. General information

NPI: 1205414927
Provider Name (Legal Business Name): JOSEPH BENJAMIN AUTRY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 TATES CREEK RD APT 1210
LEXINGTON KY
40517-3087
US

IV. Provider business mailing address

4030 TATES CREEK RD APT 1210
LEXINGTON KY
40517-3087
US

V. Phone/Fax

Practice location:
  • Phone: 571-438-7508
  • Fax:
Mailing address:
  • Phone: 571-438-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number307017
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010290
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: