Provider Demographics
NPI:1710595905
Name:DEFINE YOU COUNSELING SERVICES I DEFINE ME
Entity Type:Organization
Organization Name:DEFINE YOU COUNSELING SERVICES I DEFINE ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HARVETTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-500-9443
Mailing Address - Street 1:1205 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7426
Mailing Address - Country:US
Mailing Address - Phone:502-500-9443
Mailing Address - Fax:502-632-1432
Practice Address - Street 1:1426 S 28TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1729
Practice Address - Country:US
Practice Address - Phone:502-500-9443
Practice Address - Fax:502-632-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY251S00000XOtherTAXONOMY