Provider Demographics
NPI:1578675740
Name:RANKIN, MICHAEL DAVID (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:RANKIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 HURSTBOURNE VILLAGE DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1830
Mailing Address - Country:US
Mailing Address - Phone:502-494-2929
Mailing Address - Fax:502-267-7686
Practice Address - Street 1:2303 HURSTBOURNE VILLAGE DR
Practice Address - Street 2:STE 1100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1830
Practice Address - Country:US
Practice Address - Phone:502-494-2929
Practice Address - Fax:502-267-7686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0443101YA0400X
KY0209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0443OtherALCOHOL & DRUG COUNSELOR
KY0209OtherLMFT