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
—
—
Other
Enumeration date
06/07/2018
Last updated
06/16/2021
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