Healthcare Provider Details

I. General information

NPI: 1215328901
Provider Name (Legal Business Name): USPIRITUS.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 BROOKLAWN CAMPUS DR
LOUISVILLE KY
40218-1282
US

IV. Provider business mailing address

3121 BROOKLAWN CAMPUS DR
LOUISVILLE KY
40218-1282
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-5177
  • Fax: 502-451-0896
Mailing address:
  • Phone: 502-451-5177
  • Fax: 502-451-0896

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT MOORING
Title or Position: VP, REGULATORY AFFAIRS & QI
Credential:
Phone: 502-515-0430