Provider Demographics
NPI:1881342681
Name:LIBBY ELDRIDGE MARRIAGE FAMILY THERAPY LLC
Entity type:Organization
Organization Name:LIBBY ELDRIDGE MARRIAGE FAMILY THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:502-314-8991
Mailing Address - Street 1:1711 BARDSTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1293
Mailing Address - Country:US
Mailing Address - Phone:502-314-8991
Mailing Address - Fax:502-305-7113
Practice Address - Street 1:1711 BARDSTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1293
Practice Address - Country:US
Practice Address - Phone:502-314-8991
Practice Address - Fax:502-305-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100794850Medicaid