Individual
TRACY LEE MATTINGLY-MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC,NCC
Contact information
Practice address
1421 LEXINGTON RD, RICHMOND, KY 40475-1059
(859) 624-2454
(859) 624-2454
Mailing address
345 BOGGS RD, LONDON, KY 40744-7204
(606) 657-6579
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
105746
KY
101YP2500X
Professional Counselor
1205
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991124
ANTHEM PIN
—
Enumeration date
11/24/2015
Last updated
05/26/2016
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