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General NPI Number Information
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NPI Number | 1689499253
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Entity Type | Organization
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Legal Business Name | STAFFORD COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2632 WENDELL AVE
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City | LOUISVILLE
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State | KY
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Zip | 40205-3138
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Country | US
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Telephone | 502-260-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 TAYLORSVILLE RD # 5284
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City | LOUISVILLE
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State | KY
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Zip | 40205-2146
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Country | US
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Telephone | 502-260-0474
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLEY ELLEN STAFFORD
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Credential | LCSW
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Telephone | 502-260-0474
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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 |
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License Number State |
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