=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013021203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES KEITH NEEDLER JR. LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3906 DUPONT SQ S
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-893-6654
-----------------------------------------------------
Fax | 502-893-0000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 527 CAMP ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40203-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-637-6345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 1880
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------