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General NPI Number Information
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NPI Number | 1114658994
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Entity Type | Organization
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Legal Business Name | TERESA BOYD STRADER LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 303 MIDDLETOWN PARK PL STE H
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City | LOUISVILLE
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State | KY
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Zip | 40243-2516
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Country | US
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Telephone | 866-498-1974
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 NAT ROGERS RD
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City | NEW HAVEN
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State | KY
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Zip | 40051-5047
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Country | US
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Telephone | 502-693-5232
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERESA STRADER
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Credential | L.C.S.W.
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Telephone | 502-693-5232
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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 |
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License Number State |
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