Healthcare Provider Details

I. General information

NPI: 1639302524
Provider Name (Legal Business Name): MARC E FRISIELLO MS, EDS, LPCC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FOUNTAIN CT SUITE 225
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ SUITE 200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6021
  • Fax: 859-323-4927
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0815
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number105861
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: