Provider Demographics
NPI:1952721383
Name:TOLLER, MARIBETH (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:
Last Name:TOLLER
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 1:89 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-8069
Mailing Address - Country:US
Mailing Address - Phone:606-748-2648
Mailing Address - Fax:
Practice Address - Street 1:130 CLARK ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1207
Practice Address - Country:US
Practice Address - Phone:606-209-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health