Organization
SAFE SPACE TOO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASIRA MAH-JABEEN (CREDENTIALING AGENT)
(502) 384-5149
Entity
Organization
Contact information
Practice address
726 S PRESTON ST, LOUISVILLE, KY 40203-2320
(502) 384-5149
(502) 384-3447
Mailing address
726 S PRESTON ST, LOUISVILLE, KY 40203-2320
(502) 384-3447
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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