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General NPI Number Information
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NPI Number | 1265258446
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Entity Type | Organization
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Legal Business Name | ANGEL'S PLACE LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 939 BAXTER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40204-2046
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Country | US
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Telephone | 812-660-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 621 LOUIS COLEMAN JR DR
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City | LOUISVILLE
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State | KY
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Zip | 40211-2952
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Country | US
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Telephone | 502-356-6035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL MONTEZ PERCELL
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Credential |
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Telephone | 502-356-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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