MEDICARE: MR. WILLIAM R IRVIN M. ED., LPCC, LMHC

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	39000072A	IN
2	101YP2500X	Professional Counselor	KY-0017	KY

General Provider Information

NPI Number	:	1902881600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM R IRVIN M. ED., LPCC, LMHC

Provider Business Mailing Address
First Line	:	PO BOX 22578
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40252-0578
Country	:	US
Telephone Number	:	502-426-5106
Fax Number	:	603-457-2407

Provider Business Practice Location Address
First Line	:	7321 NEW LAGRANGE RD
Second Line	:	SUITE 203
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4800
Country	:	US
Telephone Number	:	502-426-5106
Fax Number	:	603-457-2407

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/11/2025

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