Individual
KAYLA MARIE BROCK-PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
10300 BROOKRIDGE VILLAGE BLVD STE 104, LOUISVILLE, KY 40291-4474
(502) 785-4322
Mailing address
10030 BROOKRIDGE VILLAGE BLVD, SUITE 104, LOUISVILLE, KY 40291
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
258016
KY
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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