MEDICARE: ALEVE DOUGLAS 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	262229	KY

General Provider Information

NPI Number	:	1396293981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEVE DOUGLAS LPCC

Provider Business Mailing Address
First Line	:	1039 E KENTUCKY ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1935
Country	:	US
Telephone Number	:	502-418-8247
Fax Number	:

Provider Business Practice Location Address
First Line	:	1979 RICHMOND DR STE 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1411
Country	:	US
Telephone Number	:	502-418-8247
Fax Number	:

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

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	06/16/2020

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