Healthcare Provider Details

I. General information

NPI: 1285598052
Provider Name (Legal Business Name): NELLVETTA MOORE LPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E MAGNOLIA AVE APT 2
LOUISVILLE KY
40208-2052
US

IV. Provider business mailing address

233 E MAGNOLIA AVE APT 2
LOUISVILLE KY
40208-2052
US

V. Phone/Fax

Practice location:
  • Phone: 502-718-1184
  • Fax:
Mailing address:
  • Phone: 502-718-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number288712
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: