Provider Demographics
NPI:1003194192
Name:RUCKS, MOLLY PIPER (LPCC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:PIPER
Last Name:RUCKS
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 1:902 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1620
Mailing Address - Country:US
Mailing Address - Phone:502-741-0059
Mailing Address - Fax:888-711-1902
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:#2339
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-408-3223
Practice Address - Fax:888-711-1902
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102160101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100286520Medicaid