Healthcare Provider Details

I. General information

NPI: 1346030863
Provider Name (Legal Business Name): NULEASE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 OUTER LOOP
LOUISVILLE KY
40219-4156
US

IV. Provider business mailing address

5722 OUTER LOOP
LOUISVILLE KY
40219-4156
US

V. Phone/Fax

Practice location:
  • Phone: 502-492-7455
  • Fax: 502-921-0222
Mailing address:
  • Phone: 615-568-7920
  • Fax: 615-568-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON CALES
Title or Position: CEO
Credential:
Phone: 270-465-1411