Provider Demographics
NPI:1154998417
Name:FITCH, ELIZABETH ANNE (LPCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FITCH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 KITE HOLW
Mailing Address - Street 2:
Mailing Address - City:MEALLY
Mailing Address - State:KY
Mailing Address - Zip Code:41234-9023
Mailing Address - Country:US
Mailing Address - Phone:606-792-2265
Mailing Address - Fax:
Practice Address - Street 1:485 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-8558
Practice Address - Country:US
Practice Address - Phone:859-269-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY264044OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE (LPCA)