Provider Demographics
NPI:1821205865
Name:ANSERA, LETE MEKONEN (DMIN, LCADC, MFT)
Entity Type:Individual
Prefix:DR
First Name:LETE
Middle Name:MEKONEN
Last Name:ANSERA
Suffix:
Gender:F
Credentials:DMIN, LCADC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 SOUTHERN PKWY STE 2C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1442
Mailing Address - Country:US
Mailing Address - Phone:502-777-0213
Mailing Address - Fax:855-894-9366
Practice Address - Street 1:4602 SOUTHERN PKWY STE 2C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1442
Practice Address - Country:US
Practice Address - Phone:502-777-0213
Practice Address - Fax:855-894-9366
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0871101YA0400X
KY167084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100506380Medicaid
KY4198Medicaid