Healthcare Provider Details

I. General information

NPI: 1396808069
Provider Name (Legal Business Name): EAST LOUISVILLE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 LYNDON LN SUITE 7
LOUISVILLE KY
40222-4643
US

IV. Provider business mailing address

714 LYNDON LN SUITE 7
LOUISVILLE KY
40222-4643
US

V. Phone/Fax

Practice location:
  • Phone: 502-592-8525
  • Fax: 502-425-2540
Mailing address:
  • Phone: 502-592-8525
  • Fax: 502-425-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1293
License Number StateKY

VIII. Authorized Official

Name: KIMBERLY ANN MAUGANS-SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 502-592-8525