Basic Information
| Provider Information | |||||||||
| NPI: | 1518295179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLUMP | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W MUHAMMAD ALI BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025898600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 914 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402041037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025840044 | ||||||||
| FaxNumber: | 5025898097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2009 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 1698 | KY | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 1698 | KY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 102158 | KY | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 102158 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 7100283650 | 05 | KY | MEDICAID |