Healthcare Provider Details

I. General information

NPI: 1437862059
Provider Name (Legal Business Name): KATIE MICHELLE LUTTRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATEI JEROME

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 MAIN ST
WILLISBURG KY
40078-8199
US

IV. Provider business mailing address

2084 MAIN ST
WILLISBURG KY
40078-8199
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number257281
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number257281
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: