Healthcare Provider Details

I. General information

NPI: 1104323252
Provider Name (Legal Business Name): PPL THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 HIGHVIEW CT
CRESTWOOD KY
40014-8105
US

IV. Provider business mailing address

8206 HIGHVIEW CT
CRESTWOOD KY
40014-8105
US

V. Phone/Fax

Practice location:
  • Phone: 502-262-2887
  • Fax: 502-243-9517
Mailing address:
  • Phone: 502-262-2887
  • Fax: 502-243-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY HICKS
Title or Position: OWNER
Credential: PSYCHOLOGIST
Phone: 502-262-2887