Individual
MR. MATTHEW J WAITKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
627 W 4TH ST, LEXINGTON, KY 40508-1207
(859) 253-1686
(859) 254-2743
Mailing address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1217
(859) 253-1686
(859) 254-2743
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
03/09/2007
Last updated
07/09/2007
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