Provider Demographics
NPI:1306323944
Name:LAFAVE, LEA ANN
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANN
Last Name:LAFAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8424
Mailing Address - Country:US
Mailing Address - Phone:270-982-1555
Mailing Address - Fax:270-982-1559
Practice Address - Street 1:7043 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8424
Practice Address - Country:US
Practice Address - Phone:270-982-1555
Practice Address - Fax:270-982-1559
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health