Provider Demographics
NPI:1316372428
Name:EISENMENGER, KAREN MELISA (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MELISA
Last Name:EISENMENGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PARKWAY
Mailing Address - Street 2:SUITE 3443
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217
Mailing Address - Country:US
Mailing Address - Phone:502-456-5089
Mailing Address - Fax:
Practice Address - Street 1:1169 EASTERN PARKWAY
Practice Address - Street 2:SUITE 3443
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-456-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical