Provider Demographics
NPI:1497131460
Name:CHARLET, NILES (MFTA)
Entity Type:Individual
Prefix:MRS
First Name:NILES
Middle Name:
Last Name:CHARLET
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 CENTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9195
Mailing Address - Country:US
Mailing Address - Phone:502-386-6380
Mailing Address - Fax:
Practice Address - Street 1:5910 CENTERWOOD DR
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9195
Practice Address - Country:US
Practice Address - Phone:502-386-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1073997714Medicaid