=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487282604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRISTEN MEWS, LPC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2020
-----------------------------------------------------
Last Update Date | 03/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 MILLPOND RD
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40514-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-421-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 597 BARBARO LN
-----------------------------------------------------
City | NICHOLASVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40356-7701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-379-9660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTEN MEWS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 859-421-9929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------