=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447012067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURE ESSIENCE COUNSELING AND FAMILY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 02/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1941 BISHOP LN STE 1019
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40218-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-472-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13309 HORNCASTLE WAY
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40272-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-472-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ OWNER
-----------------------------------------------------
Name | LAKESHIA K BLANTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-472-0012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------