Individual
MRS. AILEEN M BRYANT-WALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, TCADC
Contact information
Practice address
2133 W MARKET ST, LOUISVILLE, KY 40212-1532
(502) 384-5807
(502) 384-5807
Mailing address
12321 DOMINION WAY, LOUISVILLE, KY 40299-4487
(502) 417-9799
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
241211
KY
101YP2500X
Professional Counselor
Primary
245650
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100594570
—
KY
Enumeration date
12/31/2018
Last updated
07/16/2020
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