MEDICARE: DAPHNE C LUSTER LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1220	KY

General Provider Information

NPI Number	:	1104184985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE C LUSTER LPCC

Provider Business Mailing Address
First Line	:	2720 FRANKFORT AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-2769
Country	:	US
Telephone Number	:	502-454-7766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 FRANKFORT AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-2769
Country	:	US
Telephone Number	:	502-454-7766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	07/05/2024

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