Individual provider Active NPI

Elizabeth Lue Suzanne Etherton, LPCC

  • Mental Health Counselor
  • Lexington, KY
National Provider Identifier
1760894588
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
166690 Issued in KY
Practice address
3499 Blazer Pkwy Ste 440
Lexington, KY 40509-2803
Phone
(859) 338-5762
Fax
(859) 456-2949
NPI assigned
May 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 166690 KY Primary

Addresses

Primary practice location

3499 Blazer Pkwy Ste 440
Lexington, KY 40509-2803

Mailing address

996 E New Circle Rd Unit 166
Lexington, KY 40505-4127
Phone (859) 338-5762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250103000595 KY Practitioner - Mental Health Counselor 8224565213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
166690KYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Simply Empowering You Therapy PLLC Mental Health CurrentSince Oct 20, 2024 Accepting new patients
In the Scene Wellness Collective LLC Mental Health CurrentSince Dec 12, 2024 Accepting new patients
Sanders and Associates Past Accepting new patients

Locations

3499 Blazer Pkwy
Ste 440
Lexington, KY 40509
Phone (859) 338-5762

996 E New Circle Rd
Lexington, KY 40505
Phone (859) 312-7229

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1760894588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "996 E NEW CIRCLE RD UNIT 166",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405054127",
            "telephone_number": "859-338-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3499 BLAZER PKWY STE 440",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092803",
            "telephone_number": "859-338-5762",
            "fax_number": "859-456-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERTON",
        "first_name": "ELIZABETH",
        "middle_name": "LUE SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-28",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "166690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.