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General NPI Number Information
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NPI Number | 1538340690
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Entity Type | Organization
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Legal Business Name | MARY LYNN THIENEMAN
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 8521 LAGRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40242-3800
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Country | US
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Telephone | 502-644-5433
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Fax | 502-814-3745
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 22816
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City | LOUISVILLE
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State | KY
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Zip | 40252-0816
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Country | US
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Telephone | 502-644-5433
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Fax | 502-814-3745
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY LYNN THIENEMAN
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Credential | LCSW, LMFT
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Telephone | 502-644-5433
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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 | 0885
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License Number State | KY
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