MEDICARE: ENTER PEACE, PSC

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	1041C0700X	Clinical Social Worker	1512	KY

General Provider Information

NPI Number	:	1689043788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTER PEACE, PSC

Provider Business Mailing Address
First Line	:	911 BARRET AVE
Second Line	:	FRONT OFFICE
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-2048
Country	:	US
Telephone Number	:	502-585-2979
Fax Number	:	502-587-9713

Provider Business Practice Location Address
First Line	:	911 BARRET AVE
Second Line	:	FRONT OFFICE
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-2048
Country	:	US
Telephone Number	:	502-585-2979
Fax Number	:	502-587-9713

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD MARVIN VOWELS
Credential	:	MA, MSSW,LCSW
Telephone Number	:	502-585-2979

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/18/2015

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Directions to “ENTER PEACE, PSC ” Practice Location

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