Individual
LEANN DETHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
3244 WIMSATT ROAD, LORETTO, KY 40037
(270) 699-1811
Mailing address
PO BOX 105, LORETTO, KY 40037-0105
(270) 699-1811
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
KY-0911
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6254P
KY
Other
Enumeration date
09/09/2009
Last updated
12/04/2009
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