Individual
MARY ROUHOLIMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFTA
Contact information
Practice address
1714 HIGHLAND AVE, CARROLLTON, KY 41008
(502) 732-9331
Mailing address
1714 HIGHLAND AVE, CARROLLTON, KY 41008
(502) 732-9331
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
KY-08-017
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
GROUP TAX ID
KY
Enumeration date
09/26/2008
Last updated
09/26/2008
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