Provider Demographics
NPI:1487781647
Name:MILBY, RITA (LPCA)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MILBY
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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42782-0139
Mailing Address - Country:US
Mailing Address - Phone:270-432-4951
Mailing Address - Fax:270-432-5054
Practice Address - Street 1:112 SARTIN DR.
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129
Practice Address - Country:US
Practice Address - Phone:270-432-4951
Practice Address - Fax:270-432-5054
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY126368101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid