Healthcare Provider Details

I. General information

NPI: 1154800712
Provider Name (Legal Business Name): ANNE B MILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNE M BEAUMONT LPCC

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 PARK RD
LOUISVILLE KY
40223-2424
US

IV. Provider business mailing address

10401 LINN STATION RD STE 100
LOUISVILLE KY
40223-3842
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-4171
  • Fax: 502-287-0062
Mailing address:
  • Phone: 502-589-8600
  • Fax: 502-287-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number242837
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: