Healthcare Provider Details

I. General information

NPI: 1336863612
Provider Name (Legal Business Name): JUDITE MARIA JEPSEN LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 TOWNEPARK WAY STE 117
LOUISVILLE KY
40243-2538
US

IV. Provider business mailing address

10045 WINDCREST FARMS LN
LOUISVILLE KY
40291-8406
US

V. Phone/Fax

Practice location:
  • Phone: 718-986-1269
  • Fax:
Mailing address:
  • Phone: 718-986-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00646200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00646200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00646200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number301388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: