Provider Demographics
NPI:1760894588
Name:ETHERTON, ELIZABETH LUE SUZANNE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LUE SUZANNE
Last Name:ETHERTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 CUSTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4018
Mailing Address - Country:US
Mailing Address - Phone:859-474-0336
Mailing Address - Fax:
Practice Address - Street 1:3167 CUSTER DR STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4018
Practice Address - Country:US
Practice Address - Phone:859-474-0336
Practice Address - Fax:859-268-0886
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health