Organization
LOUISVILLE CENTER FOR EATING DISORDERS LLC
Active
Organization
LOUISVILLE CENTER FOR EATING DISORDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN BRENT WALLEN JD (BUSINESS MANAGER)
(502) 319-3105
Entity
Organization
Contact information
Practice address
11824 RANSUM DR # 200, LOUISVILLE, KY 40243-2802
(502) 338-0608
(502) 245-1888
Mailing address
11824 RANSUM DR STE 200, LOUISVILLE, KY 40243-2802
(502) 338-0608
(502) 245-1888
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/07/2018
Last updated
07/28/2026
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