Provider Demographics
NPI:1356853063
Name:LOUISVILLE EXPRESSIVE THERAPIES LLC
Entity Type:Organization
Organization Name:LOUISVILLE EXPRESSIVE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:IBERSHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:502-509-5380
Mailing Address - Street 1:1425 STORY AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1735
Mailing Address - Country:US
Mailing Address - Phone:502-509-5380
Mailing Address - Fax:
Practice Address - Street 1:1425 STORY AVE STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1735
Practice Address - Country:US
Practice Address - Phone:502-509-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health