Provider Demographics
NPI:1275143125
Name:KHAN, SALEHA (CSW, TCADC)
Entity Type:Individual
Prefix:
First Name:SALEHA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:CSW, TCADC
Other - Prefix:
Other - First Name:SALEHA
Other - Middle Name:
Other - Last Name:ZAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW, TCADC
Mailing Address - Street 1:720 W BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3245
Mailing Address - Country:US
Mailing Address - Phone:502-561-0943
Mailing Address - Fax:502-561-0944
Practice Address - Street 1:645 S ROY WILKINS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2072
Practice Address - Country:US
Practice Address - Phone:502-583-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242177101YA0400X
KY2529551041C0700X
KY271273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical