CLEANSE CLINIC PLLC NPI 1659726628

NPI Information

  • NPI: 1659726628
  • Provider Name: CLEANSE CLINIC, PLLC
  • Classification: Psychiatry & Neurology - 2084P0802X
  • Specialization: Addiction Psychiatry
  • Entity Type: Organization
  • CLIA Number: 18D2120455
  • Address: 645 S ROY WILKINS AVE STE 100
    LOUISVILLE, KY
    ZIP 40203
  • Phone: (502) 583-4092

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NPI Details

CLEANSE CLINIC, PLLC is an addiction psychiatry psychiatry neurology in Louisville, KY. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. CLEANSE CLINIC, PLLC NPI is 1659726628. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY
ZIP 40203-072
Phone: (502) 583-4092
Fax: (502) 371-6110

The provider's authorized official is Margaret Groll .
The authorized official title is Business Manager and has the following contact phone number (812) 987-4330.

The CLIA number assigned to this NPI record is 18D2120455 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 4/27/2016 and was last updated on 8/13/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0802XPsychiatry & NeurologyAddiction Psychiatry800212KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17100413630MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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