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NPI Code Detail

MEDICARE: LIBERTY PETTY

MEDICARE: LIBERTY PETTY
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
1101YM0800XMental Health CounselorCSW00001198KY

General Provider Information

NPI Number : 1558220624
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIBERTY PETTY
Provider Business Mailing Address
First Line : 26 WELBY RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-1519
Country : US
Telephone Number : 502-665-9153
Fax Number :
Provider Business Practice Location Address
First Line : 26 WELBY RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-1519
Country : US
Telephone Number : 502-665-9153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ LIBERTY PETTY ” Practice Location

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