Healthcare Provider Details

I. General information

NPI: 1073997714
Provider Name (Legal Business Name): COUNSELING THERAPY & MORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 HURSTBOURNE VILLAGE DR STE 1100
LOUISVILLE KY
40299-1830
US

IV. Provider business mailing address

5910 CENTERWOOD DR
CRESTWOOD KY
40014-9195
US

V. Phone/Fax

Practice location:
  • Phone: 502-386-6380
  • Fax:
Mailing address:
  • Phone: 502-386-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMFTMFA00220821
License Number StateKY

VIII. Authorized Official

Name: NILES CHARLET
Title or Position: OWNER
Credential: MSM, MFTA
Phone: 502-386-6380