Provider Demographics
NPI:1528298353
Name:SEWELL, ELLIOTT BRAM (LPCC)
Entity type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:BRAM
Last Name:SEWELL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VOLCANO RD
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-7697
Mailing Address - Country:US
Mailing Address - Phone:270-433-7900
Mailing Address - Fax:270-433-7901
Practice Address - Street 1:155 VOLCANO RD
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-7697
Practice Address - Country:US
Practice Address - Phone:270-433-7900
Practice Address - Fax:270-433-7901
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11984180OtherCAQH