Healthcare Provider Details

I. General information

NPI: 1508702895
Provider Name (Legal Business Name): MADEWELL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
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
40507-1584
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELZABA ANDERSON
Title or Position: OWNER
Credential: LPCC
Phone: 859-429-0086