Individual
THERESA FAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1448 GARDINER LN, SUITE202-203, LOUISVILLE, KY 40213-1978
(502) 456-9998
(502) 456-9923
Mailing address
1448 GARDINER LANE, SUITE 202-203, LOUISVILLE, KY 40213
(502) 456-9998
(502) 456-9923
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
KY1617
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82001066
—
KY
Enumeration date
10/03/2006
Last updated
05/22/2008
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