Provider Demographics
NPI:1891899035
Name:TACKETT, STEVEN (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TACKETT
Suffix:
Gender:M
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 WINCHESTER AVE STE 808
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7931
Mailing Address - Country:US
Mailing Address - Phone:606-325-4091
Mailing Address - Fax:606-325-4092
Practice Address - Street 1:1544 WINCHESTER AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7923
Practice Address - Country:US
Practice Address - Phone:606-325-4091
Practice Address - Fax:606-325-4092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0487101YM0800X
KY103108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health