Provider Demographics
NPI:1396808069
Name:EAST LOUISVILLE COUNSELING, PLLC
Entity type:Organization
Organization Name:EAST LOUISVILLE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAUGANS-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-592-8525
Mailing Address - Street 1:714 LYNDON LN
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4643
Mailing Address - Country:US
Mailing Address - Phone:502-592-8525
Mailing Address - Fax:502-425-2540
Practice Address - Street 1:714 LYNDON LN
Practice Address - Street 2:SUITE 7
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4643
Practice Address - Country:US
Practice Address - Phone:502-592-8525
Practice Address - Fax:502-425-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty