# WELLSPACE PSYCHIATRY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellspace Psychiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710694468
- **Authorized official:** THOMAS J FEDERER (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (502) 419-4289

## Contact information

- **Practice address:** 9700 PARK PLAZA AVE UNIT 210, LOUISVILLE, KY 40241-2287
- **Practice address phone:** (502) 419-4289
- **Mailing address:** 9700 PARK PLAZA AVE UNIT 210, LOUISVILLE, KY 40241-2287
- **Mailing address phone:** (502) 419-4289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2022
- **Last updated:** 07/25/2023