Provider Demographics
NPI:1033503974
Name:COMMONWEALTH THERAPY LOUISVILLE, PLLC
Entity Type:Organization
Organization Name:COMMONWEALTH THERAPY LOUISVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADOW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-592-1736
Mailing Address - Street 1:3703 TAYLORSVILLE RD STE 221
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1331
Mailing Address - Country:US
Mailing Address - Phone:502-592-1736
Mailing Address - Fax:502-785-4834
Practice Address - Street 1:3703 TAYLORSVILLE RD STE 211
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1331
Practice Address - Country:US
Practice Address - Phone:502-592-1736
Practice Address - Fax:502-785-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty