Basic Information
| Provider Information | |||||||||
| NPI: | 1386662773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAFOLLETTE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 690 | ||||||||
| Address2: | 130 VINE STREET | ||||||||
| City: | SHEPHERDSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401650690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025891100 | ||||||||
| FaxNumber: | 5025898771 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W MUHAMMAD ALI BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025898600 | ||||||||
| FaxNumber: | 5025898771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | TEMP-2005-65 | KY | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 1452 | KY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.