Healthcare Provider Details

I. General information

NPI: 1740569888
Provider Name (Legal Business Name): MICHELLE WREN MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CHAMBERLAIN LN
LOUISVILLE KY
40241-1159
US

IV. Provider business mailing address

4601 CHAMBERLAIN LN
LOUISVILLE KY
40241-1159
US

V. Phone/Fax

Practice location:
  • Phone: 502-384-2844
  • Fax: 502-384-2855
Mailing address:
  • Phone: 502-384-2844
  • Fax: 502-384-2855

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: