Provider Demographics
NPI: | 1376818815 |
---|---|
Name: | HEARTFELT SOLUTIONS, PLLC |
Entity Type: | Organization |
Organization Name: | HEARTFELT SOLUTIONS, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PSYCHOLOGIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KELLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 502-423-0332 |
Mailing Address - Street 1: | 216 W JOHN FITCH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BARDSTOWN |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40004-1115 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-349-9554 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 800 STONE CREEK PKWY STE 7 |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40223-5366 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-423-0332 |
Practice Address - Fax: | 502-423-0337 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-16 |
Last Update Date: | 2020-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
1-09-5130 | 103K00000X | |
KY | 1548 | 103T00000X |
133N00000X, 133V00000X, 224Z00000X, 225100000X, 225200000X, 225X00000X, 2355S0801X, 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100151670 | Medicaid | |
P400031243 | Other | MEDICARE PTAN |