MEDICARE: MARIE COMA MED

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1891286399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE COMA MED

Provider Business Mailing Address
First Line	:	307 MCCREADY AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-2751
Country	:	US
Telephone Number	:	412-848-2470
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD STE 126
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3284
Country	:	US
Telephone Number	:	502-416-1416
Fax Number	:

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

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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Directions to “ MARIE COMA MED” Practice Location

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