MEDICARE: MRS. ILENE CRYSLER BOSSCHER LMFT

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	106H00000X	Marriage & Family Therapist	0808	KY

General Provider Information

NPI Number	:	1417200890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILENE CRYSLER BOSSCHER LMFT

Provider Business Mailing Address
First Line	:	1313 LYNDON LN
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-552-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 LYNDON LN
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-552-7319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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