MEDICARE: POWER INTO PURPOSE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851105878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWER INTO PURPOSE LLC

Provider Business Mailing Address
First Line	:	901 S 15TH ST STE 117
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S 15TH ST STE 117
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1369
Country	:	US
Telephone Number	:	502-744-2105
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. DONNA MARIE RUSSELL
Credential	:	LCSW
Telephone Number	:	502-408-4969

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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Directions to “POWER INTO PURPOSE LLC ” Practice Location

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