MEDICARE: LILY OF HOPE PSYCHIATRY SERVICES

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1255207973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY OF HOPE PSYCHIATRY SERVICES

Provider Business Mailing Address
First Line	:	3902 OLD BROWNSBORO HILLS RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-1637
Country	:	US
Telephone Number	:	216-548-7202
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 OLD BROWNSBORO HILLS RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-1637
Country	:	US
Telephone Number	:	502-208-7190
Fax Number	:	732-832-3732

Authorized Official
Title or Position	:	OWNER
Name	:	YVONNE OWEN
Credential	:	APRN, PMHNP-BC
Telephone Number	:	216-548-7202

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	04/16/2026

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