Provider Demographics
NPI:1760622377
Name:DANIEL, JUDITH EVANS (M ED, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:EVANS
Last Name:DANIEL
Suffix:
Gender:F
Credentials:M ED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1101
Mailing Address - Country:US
Mailing Address - Phone:502-473-0063
Mailing Address - Fax:
Practice Address - Street 1:2021 ALTA AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1101
Practice Address - Country:US
Practice Address - Phone:502-473-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist