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General NPI Number Information
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NPI Number | 1144501164
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Entity Type | Organization
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Legal Business Name | LIFE SKILL BUILDING PLLC
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Dates
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Enumeration Date | 09/03/2011
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Last Update Date | 09/03/2011
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Provider Practice Location Address
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Address Line | 3111 SUMMERFIELD DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-3329
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Country | US
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Telephone | 502-415-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 SUMMERFIELD DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-3329
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Country | US
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Telephone | 502-415-0321
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLY ANNE SCOTT
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Credential | MSOTR/L, LMTB
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Telephone | 502-415-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R3522
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License Number State | KY
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