MEDICARE: MAMADOU FALL LPCC

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	101Y00000X	Counselor	1319	KY

General Provider Information

NPI Number	:	1922463298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMADOU FALL LPCC

Provider Business Mailing Address
First Line	:	1300 S 4TH ST
Second Line	:	SUITE 240
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2314
Country	:	US
Telephone Number	:	502-650-3804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S 4TH ST
Second Line	:	SUITE 240
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2314
Country	:	US
Telephone Number	:	502-650-3804
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	04/26/2016

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