Provider Demographics
NPI:1972968378
Name:PUCKETT, LORETTA (LPCC, LCADC, NCC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LPCC, LCADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 FERN VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3552
Mailing Address - Country:US
Mailing Address - Phone:502-936-4905
Mailing Address - Fax:
Practice Address - Street 1:3215 FERN VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3552
Practice Address - Country:US
Practice Address - Phone:502-554-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional