1750533626 NPI number — TRIUNE COUNSELING SERVICES, PLLC

Table of content: (NPI 1750533626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750533626 NPI number — TRIUNE COUNSELING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIUNE COUNSELING SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MICHAEL B. TAYLOR, LMFT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750533626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2303 HURSTBOURNE VILLAGE DR
Provider Second Line Business Mailing Address:
STE 1100
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40299-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-387-8802
Provider Business Mailing Address Fax Number:
502-618-2875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2303 HURSTBOURNE VILLAGE DR
Provider Second Line Business Practice Location Address:
STE 1100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-387-8802
Provider Business Practice Location Address Fax Number:
502-618-2875
Provider Enumeration Date:
10/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
SOLE MEMBER-OWNER
Authorized Official Telephone Number:
502-387-8802

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  KY-0453MFT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1780800334 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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