Provider Demographics
NPI:1740769900
Name:INNOVATIVE FAMILY THERAPY
Entity type:Organization
Organization Name:INNOVATIVE FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:GORHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, LMFT, GC-C
Authorized Official - Phone:502-612-9129
Mailing Address - Street 1:13121 EASTPOINT PARK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4192
Mailing Address - Country:US
Mailing Address - Phone:502-612-9129
Mailing Address - Fax:
Practice Address - Street 1:13121 EASTPOINT PARK BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4192
Practice Address - Country:US
Practice Address - Phone:502-612-9129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty