Healthcare Provider Details

I. General information

NPI: 1659014314
Provider Name (Legal Business Name): ELZABA ANDERSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E MAIN ST
LEXINGTON KY
40507-1512
US

IV. Provider business mailing address

348 E MAIN ST
LEXINGTON KY
40507-1512
US

V. Phone/Fax

Practice location:
  • Phone: 859-429-0086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number271965
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: