Provider Demographics
NPI:1992164925
Name:FAMILY THERAPY OF LOUISVILLE, LLC
Entity type:Organization
Organization Name:FAMILY THERAPY OF LOUISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CURRY
Authorized Official - Last Name:HOERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-262-0171
Mailing Address - Street 1:431 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1803
Mailing Address - Country:US
Mailing Address - Phone:502-380-6411
Mailing Address - Fax:502-290-6800
Practice Address - Street 1:161 SAINT MATTHEWS AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3145
Practice Address - Country:US
Practice Address - Phone:502-380-6411
Practice Address - Fax:502-290-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty