MEDICARE: DANIELLE LAWRENCE

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	101Y00000X	Counselor
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861082323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LAWRENCE

Provider Business Mailing Address
First Line	:	2500 W BURNETT AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1616
Country	:	US
Telephone Number	:	317-529-8095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W BURNETT AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1616
Country	:	US
Telephone Number	:	317-529-8095
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	01/19/2021

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Directions to “ DANIELLE LAWRENCE ” Practice Location

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