Provider Demographics
NPI:1114658994
Name:TERESA BOYD STRADER LLC
Entity Type:Organization
Organization Name:TERESA BOYD STRADER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-693-5232
Mailing Address - Street 1:1711 NAT ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051-5047
Mailing Address - Country:US
Mailing Address - Phone:502-693-5232
Mailing Address - Fax:
Practice Address - Street 1:303 MIDDLETOWN PARK PL STE H
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2516
Practice Address - Country:US
Practice Address - Phone:866-498-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty