Healthcare Provider Details

I. General information

NPI: 1629982517
Provider Name (Legal Business Name): SARAH MORTENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BARDSTOWN RD UNIT A-2
MT WASHINGTON KY
40047-7669
US

IV. Provider business mailing address

1200 N BARDSTOWN RD UNIT A-2
MT WASHINGTON KY
40047-7669
US

V. Phone/Fax

Practice location:
  • Phone: 502-912-1038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCSW00001855
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: