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General NPI Number Information
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NPI Number | 1063938785
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Entity Type | Organization
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Legal Business Name | HOPE THERAPEUTIC INTERVENTIONS LLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2210 GOLDSMITH LN STE 202
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City | LOUISVILLE
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State | KY
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Zip | 40218-1038
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Country | US
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Telephone | 502-656-0963
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 GOLDSMITH LN STE 202
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City | LOUISVILLE
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State | KY
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Zip | 40218-1038
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Country | US
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Telephone | 502-656-0963
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHON WHITE
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Credential | LCSW
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Telephone | 502-656-0963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3891
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License Number State | KY
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