=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053058321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHSHEBA ALEXANDER NIETO LPCC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2022
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1908 N MAIN ST STE 240
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-439-2662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 OAK LN
-----------------------------------------------------
City | LILY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40740-3388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-231-7957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 283490
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------