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Organization
WELLSPACE PSYCHIATRY LLC
Active
Organization
WELLSPACE PSYCHIATRY LLC
Active
Other names
Wellspace Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J FEDERER (OWNER/ADMINISTRATOR)
(502) 419-4289
Entity
Organization
Contact information
Practice address
9700 PARK PLAZA AVE UNIT 210, LOUISVILLE, KY 40241-2287
(502) 419-4289
Mailing address
9700 PARK PLAZA AVE UNIT 210, LOUISVILLE, KY 40241-2287
(502) 419-4289
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/02/2022
Last updated
07/25/2023
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