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Individual

MRS. MYRTLE W PROCTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
501 DARBY CREEK RD, SUITE 67, LEXINGTON, KY 40509
(859) 335-0375
(859) 335-0170
Mailing address
501 DARBY CREEK RD, SUITE 67, LEXINGTON, KY 40509
(859) 335-0375
(859) 335-0170

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
416
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000198964
ANTHEM BC BS
KY
01
29101896
MEDICAID
KY
05
29201894
KY
Enumeration date
01/09/2007
Last updated
07/08/2007
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