Provider Demographics
NPI:1194972141
Name:MILBY, JETONA K (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JETONA
Middle Name:K
Last Name:MILBY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E MAIN ST STE 99
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1334
Mailing Address - Country:US
Mailing Address - Phone:270-358-6131
Mailing Address - Fax:270-358-6582
Practice Address - Street 1:104 E MAIN ST STE 99
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1334
Practice Address - Country:US
Practice Address - Phone:270-358-6131
Practice Address - Fax:270-358-6582
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY0799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100464060Medicaid