Provider Demographics
NPI:1447391115
Name:MASSA, JOE V (LPA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:V
Last Name:MASSA
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5126
Mailing Address - Country:US
Mailing Address - Phone:270-726-3629
Mailing Address - Fax:270-726-3620
Practice Address - Street 1:237 E 6TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1917
Practice Address - Country:US
Practice Address - Phone:270-726-3629
Practice Address - Fax:270-726-3620
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0548101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid