Healthcare Provider Details

I. General information

NPI: 1124733415
Provider Name (Legal Business Name): POPS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 DIXIE HWY STE 330
LOUISVILLE KY
40216-4170
US

IV. Provider business mailing address

3934 DIXIE HWY STE 330
LOUISVILLE KY
40216-4170
US

V. Phone/Fax

Practice location:
  • Phone: 502-409-4357
  • Fax: 502-873-5048
Mailing address:
  • Phone: 502-409-4357
  • Fax: 502-873-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: EVA ARCHIE
Title or Position: CLINICAL SUPERVISOR
Credential: LCADC, LMFT, SAP
Phone: 502-409-4357