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General NPI Number Information
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NPI Number | 1326353194
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Entity Type | Individual
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Provider Name | LAURIE QUALAH LPAT
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Gender | Female
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 2225 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1003
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Country | US
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Telephone | 502-589-8600
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Fax | 502-589-8771
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Provider Business Mailing Address
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Address Line | 1436 S FLOYD ST
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City | LOUISVILLE
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State | KY
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Zip | 40208-2016
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Country | US
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Telephone | 502-552-0946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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