Provider Demographics
NPI:1962246264
Name:YOURPATH KY LLC
Entity type:Organization
Organization Name:YOURPATH KY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:859-514-2638
Mailing Address - Street 1:700 RAYMOND AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1778
Mailing Address - Country:US
Mailing Address - Phone:612-895-1510
Mailing Address - Fax:833-201-9490
Practice Address - Street 1:71 CAVALIER BLVD STE 206
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5169
Practice Address - Country:US
Practice Address - Phone:612-895-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health