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General NPI Number Information
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NPI Number | 1760894588
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Entity Type | Individual
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Provider Name | ELIZABETH LUE SUZANNE ETHERTON LPCC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3499 BLAZER PKWY STE 440
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City | LEXINGTON
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State | KY
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Zip | 40509-2803
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Country | US
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Telephone | 859-338-5762
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Fax | 859-456-2949
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Provider Business Mailing Address
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Address Line | 996 E NEW CIRCLE RD UNIT 166
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City | LEXINGTON
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State | KY
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Zip | 40505-4127
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Country | US
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Telephone | 859-338-5762
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 166690
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License Number State | KY
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