Healthcare Provider Details

I. General information

NPI: 1356741870
Provider Name (Legal Business Name): KAREN BESS MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 GOLDSMITH LN
LOUISVILLE KY
40218-1018
US

IV. Provider business mailing address

2239 PAYNE ST
LOUISVILLE KY
40206-2870
US

V. Phone/Fax

Practice location:
  • Phone: 502-458-1171
  • Fax:
Mailing address:
  • Phone: 502-648-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2012-013
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: