Healthcare Provider Details

I. General information

NPI: 1457782443
Provider Name (Legal Business Name): MICHELE BEAUDET-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 MAIN ST
SHELBYVILLE KY
40065-1224
US

IV. Provider business mailing address

900 BEASLEY ST SUITE 120
LEXINGTON KY
40509-4266
US

V. Phone/Fax

Practice location:
  • Phone: 502-321-7617
  • Fax:
Mailing address:
  • Phone: 859-254-1035
  • Fax: 859-254-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: