Provider Demographics
NPI:1255497178
Name:LUTHER, BRENDA GALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:GALE
Last Name:LUTHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SYCAMORE ST
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2469
Mailing Address - Country:US
Mailing Address - Phone:270-763-6644
Mailing Address - Fax:270-765-2452
Practice Address - Street 1:200 SYCAMORE ST
Practice Address - Street 2:SUITE 134
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2469
Practice Address - Country:US
Practice Address - Phone:270-763-6644
Practice Address - Fax:270-765-2452
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0301101YA0400X
MIMI6401004980101YP2500X
KYKY0057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional