Provider Demographics
NPI:1518734847
Name:THERAPIST NEED THERAPY 2
Entity Type:Organization
Organization Name:THERAPIST NEED THERAPY 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-2036
Mailing Address - Street 1:1939 GOLDSMITH LN STE 215
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3178
Mailing Address - Country:US
Mailing Address - Phone:502-377-5521
Mailing Address - Fax:
Practice Address - Street 1:1939 GOLDSMITH LN STE 215
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3178
Practice Address - Country:US
Practice Address - Phone:502-377-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPIST NEED THERAPY 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health