MEDICARE: BRENDA DREXLER LCSW

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	1671	KY

General Provider Information

NPI Number	:	1558464628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA DREXLER LCSW

Provider Business Mailing Address
First Line	:	3509 POPLAR LEVEL RD # B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1009
Country	:	US
Telephone Number	:	502-456-9998
Fax Number	:	502-456-9923

Provider Business Practice Location Address
First Line	:	3509 POPLAR LEVEL RD # B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1009
Country	:	US
Telephone Number	:	502-456-9998
Fax Number	:	502-456-9923

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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