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General NPI Number Information
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NPI Number | 1386140358
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Entity Type | Organization
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Legal Business Name | LOUISVILLE MENTAL HEALTH GROUP
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD STE 322
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City | LOUISVILLE
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State | KY
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Zip | 40218-3241
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Country | US
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Telephone | 502-417-2299
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Fax | 502-888-9771
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Provider Business Mailing Address
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Address Line | 4229 BARDSTOWN RD STE 322
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City | LOUISVILLE
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State | KY
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Zip | 40218-3241
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Country | US
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Telephone | 502-417-2299
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Fax | 502-888-9771
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KIMBERLY MARIE SULLIVAN
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Credential | LCSW
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Telephone | 502-417-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3275
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License Number State | KY
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