Basic Information
| Provider Information | |||||||||
| NPI: | 1225406390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEILLER | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 KIRKLEVINGTON DR | ||||||||
| Address2: | APT 65 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405172402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596093379 | ||||||||
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| Practice Location | |||||||||
| Address1: | 269 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403612126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599876127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2015 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1790731081 | 05 | KY | MEDICAID |