Provider Demographics
NPI:1356713804
Name:PFAU, MINDY (LPCC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:PFAU
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 1:757 HANNAH LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-7090
Mailing Address - Country:US
Mailing Address - Phone:606-315-8637
Mailing Address - Fax:
Practice Address - Street 1:757 HANNAH LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-7090
Practice Address - Country:US
Practice Address - Phone:606-315-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171816101YS0200X
KY267149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool