Provider Demographics
NPI:1265081798
Name:HENDRICKS, TIVOLI (LPCC)
Entity type:Individual
Prefix:
First Name:TIVOLI
Middle Name:
Last Name:HENDRICKS
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 1:4325 COBBLESTONE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4673
Mailing Address - Country:US
Mailing Address - Phone:859-421-7078
Mailing Address - Fax:
Practice Address - Street 1:176 PASADENA DR STE 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2900
Practice Address - Country:US
Practice Address - Phone:859-421-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health