Basic Information
| Provider Information | |||||||||
| NPI: | 1891153300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARAMORE | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 PENICK AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427431023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704057444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 CRANES ROOST CT | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427013650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707652605 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LPCCCA00224178 | KY | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.