Provider Demographics
NPI:1437589611
Name:TRAMMELL, DERRICK (LPCC-S)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9599 SUMMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-9055
Mailing Address - Country:US
Mailing Address - Phone:859-635-0500
Mailing Address - Fax:
Practice Address - Street 1:912 BANKLICK ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3029
Practice Address - Country:US
Practice Address - Phone:859-442-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional