Healthcare Provider Details

I. General information

NPI: 1407500903
Provider Name (Legal Business Name): DEVRON DEMONT HOBBS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 08/07/2024
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 GOLDSMITH LN STE 230
LOUISVILLE KY
40218-1070
US

IV. Provider business mailing address

4216 TELOVI CT
LOUISVILLE KY
40241-1537
US

V. Phone/Fax

Practice location:
  • Phone: 502-618-3317
  • Fax: 502-331-6062
Mailing address:
  • Phone: 502-224-4145
  • Fax: 502-331-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: