Individual
THADDEUS MATTMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
(859) 281-3867
Mailing address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
(859) 281-3867
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1524
KY
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
01/12/2007
Last updated
03/07/2018
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