Provider Demographics
NPI:1194423269
Name:THE NURTURED SOUL COUNSELING & COACHING, LLC
Entity type:Organization
Organization Name:THE NURTURED SOUL COUNSELING & COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-373-1898
Mailing Address - Street 1:1949 GOLDSMITH LN STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3096
Mailing Address - Country:US
Mailing Address - Phone:502-373-1898
Mailing Address - Fax:502-785-4003
Practice Address - Street 1:1949 GOLDSMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3096
Practice Address - Country:US
Practice Address - Phone:502-373-1898
Practice Address - Fax:502-785-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100702710Medicaid