Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 102160 | KY |
NPI | 1003194192 |
---|---|
Provider Name | Molly Piper Rucks |
First Address | Louisville, KY 40206-1620 |
Second Address | Louisville, KY 40217-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 13/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100286520 | (05) | KY |