Provider Demographics
NPI:1386955474
Name:BLUEGRASS FAMILY THERAPY
Entity type:Organization
Organization Name:BLUEGRASS FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:AREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:859-492-9955
Mailing Address - Street 1:1405 FORT BRAMLETT RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9062
Mailing Address - Country:US
Mailing Address - Phone:859-492-9955
Mailing Address - Fax:
Practice Address - Street 1:1405 FORT BRAMLETT RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9062
Practice Address - Country:US
Practice Address - Phone:859-492-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-05-0001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty