Healthcare Provider Details

I. General information

NPI: 1265154199
Provider Name (Legal Business Name): HEALING JOURNEY THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 GOLDSMITH LN STE 103
LOUISVILLE KY
40218-3096
US

IV. Provider business mailing address

1949 GOLDSMITH LN STE 103
LOUISVILLE KY
40218-3096
US

V. Phone/Fax

Practice location:
  • Phone: 502-325-3104
  • Fax:
Mailing address:
  • Phone: 502-325-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY E MILLER
Title or Position: OWNER
Credential: LCSW, PMH-C
Phone: 502-325-3104