Provider Demographics
NPI:1124344726
Name:OWENS, KEISHA KULANA (LCSW)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:KULANA
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34292
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40232-4292
Mailing Address - Country:US
Mailing Address - Phone:502-526-1811
Mailing Address - Fax:
Practice Address - Street 1:2520 BARDSTOWN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2672
Practice Address - Country:US
Practice Address - Phone:502-526-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical