Healthcare Provider Details

I. General information

NPI: 1932484862
Provider Name (Legal Business Name): LORRI LIVERS HOUCK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CRESCENT AVE
LOUISVILLE KY
40206-1525
US

IV. Provider business mailing address

105 CRESCENT AVE
LOUISVILLE KY
40206-1525
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-1999
  • Fax: 502-896-1004
Mailing address:
  • Phone: 502-897-1999
  • Fax: 502-896-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LORRI LIVERS HOUCK
Title or Position: SOLE MEMBER
Credential: APRN, PMHNP-BC
Phone: 502-275-9898