Provider Demographics
NPI:1386185437
Name:ERVIN, MEREDITH BROOKE (LPCC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:BROOKE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 TWIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3820
Mailing Address - Country:US
Mailing Address - Phone:502-276-5736
Mailing Address - Fax:
Practice Address - Street 1:10351 LINN STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3816
Practice Address - Country:US
Practice Address - Phone:502-276-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252716101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor