Provider Demographics
NPI:1750533626
Name:TRIUNE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:TRIUNE COUNSELING SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:502-387-8802
Mailing Address - Street 1:2303 HURSTBOURNE VILLAGE DR
Mailing Address - Street 2:STE 1100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1830
Mailing Address - Country:US
Mailing Address - Phone:502-387-8802
Mailing Address - Fax:502-618-2875
Practice Address - Street 1:2303 HURSTBOURNE VILLAGE DR
Practice Address - Street 2:STE 1100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1830
Practice Address - Country:US
Practice Address - Phone:502-387-8802
Practice Address - Fax:502-618-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0453MFT261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780800334OtherNPI