MEDICARE: MALEEYAH K GUMBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	306097	KY

General Provider Information

NPI Number	:	1073242061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALEEYAH K GUMBS

Provider Business Mailing Address
First Line	:	10401 LINN STATION RD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3842
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 E BROADWAY STE 125
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1184
Country	:	US
Telephone Number	:	502-587-8833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	03/02/2026

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