Healthcare Provider Details

I. General information

NPI: 1881909422
Provider Name (Legal Business Name): WISDOM OF THE HEART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 2ND ST SUITE 207
LEXINGTON KY
40508-9002
US

IV. Provider business mailing address

535 W 2ND ST SUITE 207
LEXINGTON KY
40508-9002
US

V. Phone/Fax

Practice location:
  • Phone: 859-338-8720
  • Fax:
Mailing address:
  • Phone: 859-338-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0559
License Number StateKY

VIII. Authorized Official

Name: STEVEN B. SMITH
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 859-338-8720