Organization
FRESH ROUTES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP ANTONIO THOMPSON MFT (CEO)
(502) 324-2199
Entity
Organization
Contact information
Practice address
3146 W BROADWAY, LOUISVILLE, KY 40211-1441
(502) 776-0262
Mailing address
743 E BROADWAY STE 291, LOUISVILLE, KY 40202-1711
(502) 608-7640
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/26/2018
Last updated
06/26/2018
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