Basic Information
| Provider Information | |||||||||
| NPI: | 1851721732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TRAVIS | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 THUNDERSTICK DR STE 1104 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405059009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
| FaxNumber: | 8592542075 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 THUNDERSTICK DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405059010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2013 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 248480 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 248480 | KY | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.