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General NPI Number Information
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NPI Number | 1356996730
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Entity Type | Organization
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Legal Business Name | MOORMAN MENTAL HEALTH SERVICES LLC.
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 3276 COMMERCE CENTER PL
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City | LOUISVILLE
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State | KY
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Zip | 40211-1900
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Country | US
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Telephone | 502-554-6245
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 OEHRLE DR
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City | LOUISVILLE
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State | KY
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Zip | 40216-4724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER; EMPLOYEE
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Name | ASHA MOORMAN
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Credential |
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Telephone | 502-554-6245
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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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