Provider Demographics
NPI:1689088346
Name:LISTON, ANTHONY (MSC, LPCC, CADC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LISTON
Suffix:
Gender:M
Credentials:MSC, LPCC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ROCKCREST WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-3202
Mailing Address - Country:US
Mailing Address - Phone:502-939-9393
Mailing Address - Fax:
Practice Address - Street 1:219 ROCKCREST WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3202
Practice Address - Country:US
Practice Address - Phone:502-939-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1267101YA0400X
KY1640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)