MEDICARE: LORD COUNSELING SERVICE LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1750078150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORD COUNSELING SERVICE LLC

Provider Business Mailing Address
First Line	:	1004 VANBRUGH CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 STRADER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4025
Country	:	US
Telephone Number	:	859-489-3736
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LYNN LORD
Credential	:	LPCC
Telephone Number	:	859-489-3736

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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Directions to “LORD COUNSELING SERVICE LLC ” Practice Location

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