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General NPI Number Information
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NPI Number | 1194516930
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Entity Type | Individual
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Provider Name | LYNETTE E. ANDERSON LCADCA, CSW, CBIS
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 100 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2443
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Country | US
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Telephone | 715-820-0856
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Fax |
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Provider Business Mailing Address
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Address Line | 780 DOE HAVEN RD
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City | EKRON
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State | KY
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Zip | 40117-8836
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Country | US
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Telephone | 715-820-0856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 297517
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 259474
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 301371
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License Number State | KY
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