=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548675366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYTI MICHEL LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2014
-----------------------------------------------------
Last Update Date | 05/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SEARS AVE STE 205
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-627-0830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1076 S DIXIE BLVD
-----------------------------------------------------
City | RADCLIFF
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40160-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-735-2350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 239818
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 239818
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------