Basic Information
| Provider Information | |||||||||
| NPI: | 1184286882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOLENG | ||||||||
| FirstName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9523 US HIGHWAY 42 UNIT 509 | ||||||||
| Address2: | |||||||||
| City: | PROSPECT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400595020 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8007 LYNDON CENTRE WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 242372 | KY | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.