Provider Demographics
NPI:1871866046
Name:SIMPSON, JUSTINE (LPCA, MED)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPCA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204
Mailing Address - Country:US
Mailing Address - Phone:502-589-8070
Mailing Address - Fax:502-562-5691
Practice Address - Street 1:914 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204
Practice Address - Country:US
Practice Address - Phone:502-589-8070
Practice Address - Fax:502-562-5691
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional