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General NPI Number Information
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NPI Number | 1992492276
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Entity Type | Organization
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Legal Business Name | EPIPHANY PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 711 BRENDON HILLS PL
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City | LOUISVILLE
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State | KY
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Zip | 40245-5718
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Country | US
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Telephone | 313-408-1905
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Fax |
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Provider Business Mailing Address
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Address Line | 711 BRENDON HILLS PL
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City | LOUISVILLE
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State | KY
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Zip | 40245-5718
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Country | US
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Telephone | 313-408-1905
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ADMIN
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Name | JACQUELINE SANDERS
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Credential |
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Telephone | 502-630-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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