Healthcare Provider Details

I. General information

NPI: 1841738481
Provider Name (Legal Business Name): LATOSHA PERRY M.ED.,LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S HURSTBOURNE PKWY
LOUISVILLE KY
40222-5757
US

IV. Provider business mailing address

4109 SHADY VILLA DR
LOUISVILLE KY
40219-1541
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-7325
  • Fax:
Mailing address:
  • Phone: 502-775-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number171773
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: