Provider Demographics
NPI:1508563040
Name:SEVERO THERAPY LLC
Entity Type:Organization
Organization Name:SEVERO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-627-0093
Mailing Address - Street 1:3400 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5428
Mailing Address - Country:US
Mailing Address - Phone:502-627-0093
Mailing Address - Fax:502-499-4431
Practice Address - Street 1:3400 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5428
Practice Address - Country:US
Practice Address - Phone:502-627-0093
Practice Address - Fax:502-499-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health