Provider Demographics
NPI:1548507056
Name:FRAZIER, MISTY (LCSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WINDSOR DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1626
Mailing Address - Country:US
Mailing Address - Phone:859-404-4649
Mailing Address - Fax:
Practice Address - Street 1:223 WINDSOR DR STE 3
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1626
Practice Address - Country:US
Practice Address - Phone:859-404-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100431650Medicaid
KY30610026Medicaid
KY7100431650Medicaid
KYK225232Medicare PIN
KYK225233Medicare PIN
KYK225231Medicare PIN