=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740651413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER WORMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2015
-----------------------------------------------------
Last Update Date | 09/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 BRECKENRIDGE LN STE 205
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-536-7187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 BRECKENRIDGE LN STE 205
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-536-7187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 244274
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------