Provider Demographics
NPI:1447842711
Name:JANUARY, DEMETRIA TYRAU (LPCC, NCC)
Entity type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:TYRAU
Last Name:JANUARY
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12123 SHELBYVILLE RD STE 100413
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1079
Mailing Address - Country:US
Mailing Address - Phone:502-641-1877
Mailing Address - Fax:
Practice Address - Street 1:12123 SHELBYVILLE RD STE 100413
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1079
Practice Address - Country:US
Practice Address - Phone:502-641-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health