Basic Information
| Provider Information | |||||||||
| NPI: | 1003145145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 W BROADWAY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025610943 | ||||||||
| FaxNumber: | 5025610944 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 STATE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471504916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129147038 | ||||||||
| FaxNumber: | 8127486035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2009 | ||||||||
| LastUpdateDate: | 10/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 87000393A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.