Provider Demographics
NPI:1487195434
Name:ELDRIDGE, LIBBY JURADO (MA LMFT)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:JURADO
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:ROSAURA
Other - Last Name:JURADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTA
Mailing Address - Street 1:1711 BARDSTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1293
Mailing Address - Country:US
Mailing Address - Phone:502-314-8991
Mailing Address - Fax:
Practice Address - Street 1:1711 BARDSTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1293
Practice Address - Country:US
Practice Address - Phone:502-314-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist