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General NPI Number Information
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NPI Number | 1235911421
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Entity Type | Organization
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Legal Business Name | CDS THERAPEUTIC COUNSELING & CASE MANAGEMENT, LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 1213 ORMSBY LN
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City | LOUISVILLE
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State | KY
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Zip | 40222-3862
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Country | US
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Telephone | 502-767-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 ORMSBY LN
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City | LOUISVILLE
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State | KY
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Zip | 40222-3862
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Country | US
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Telephone | 502-767-6220
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL THERAPIST
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Name | MRS. CAROLE LYNNESE SALLIS
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Credential | M. ED., M.S., M.S.
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Telephone | 502-767-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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