MEDICARE: WISDOM OF THE HEART, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0059	KY

General Provider Information

NPI Number	:	1023358389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISDOM OF THE HEART, INC.

Provider Business Mailing Address
First Line	:	535 W SECOND ST STE 207
Second Line	:	SUITE 207
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	859-338-8720
Fax Number	:	859-255-5385

Provider Business Practice Location Address
First Line	:	535 W SECOND ST STE 207
Second Line	:	SUITE 207
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	859-338-8720
Fax Number	:	859-255-5385

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN B SMITH
Credential	:	PH.D.
Telephone Number	:	859-338-8720

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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Directions to “WISDOM OF THE HEART, INC. ” Practice Location

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