Provider Demographics
NPI:1407546765
Name:GAUTIER, IVA ALLISON (LPCA)
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:ALLISON
Last Name:GAUTIER
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 1:1925 TIMBER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9429
Mailing Address - Country:US
Mailing Address - Phone:859-329-9440
Mailing Address - Fax:
Practice Address - Street 1:915 LEAWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-7776
Practice Address - Country:US
Practice Address - Phone:859-559-0279
Practice Address - Fax:502-470-5752
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health