Healthcare Provider Details

I. General information

NPI: 1194609990
Provider Name (Legal Business Name): YASMI T BLUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PLACE VERT
LOUISVIILE KY
40203
US

IV. Provider business mailing address

1004 PLACE VERT
LOUISVIILE KY
40203
US

V. Phone/Fax

Practice location:
  • Phone: 502-812-8187
  • Fax:
Mailing address:
  • Phone: 502-812-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number290541
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: