Provider Demographics
NPI:1952445017
Name:THERAPEUTIC COLLABORTIVE
Entity Type:Organization
Organization Name:THERAPEUTIC COLLABORTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:LUKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-572-0400
Mailing Address - Street 1:525 LICKING PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41071
Mailing Address - Country:US
Mailing Address - Phone:859-572-0400
Mailing Address - Fax:859-442-3363
Practice Address - Street 1:525 LICKING PIKE
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-572-0400
Practice Address - Fax:859-442-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty