MEDICARE: DEFINE YOU COUNSELING SERVICES I DEFINE ME

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251S00000X	OTHER	KY	TAXONOMY

General Provider Information

NPI Number	:	1710595905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFINE YOU COUNSELING SERVICES I DEFINE ME

Provider Business Mailing Address
First Line	:	1205 WINDMILL LN
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7426
Country	:	US
Telephone Number	:	502-500-9443
Fax Number	:	502-632-1432

Provider Business Practice Location Address
First Line	:	1426 S 28TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-1729
Country	:	US
Telephone Number	:	502-500-9443
Fax Number	:	502-632-1432

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HARVETTA K RAY
Credential	:	LCSW
Telephone Number	:	502-500-9443

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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