Organization
ML CANTRELL PSYCHOTHERAPEUTIC SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY LOU CANTRELL MA, LPP (SOLE OWNER)
(606) 743-2407
Entity
Organization
Contact information
Practice address
1219 W MAIN ST, WEST LIBERTY, KY 41472-2161
(606) 743-2407
Mailing address
849 HIGHWAY 191, WEST LIBERTY, KY 41472-8315
(606) 743-2407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSYPPR00193411
KY
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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