NPI |
1669003372 |
The country code in the location address of the provider being identified. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Organization Name Legal Business Name |
CRIMSON DOVE COUNSELING SERVICES INC |
The date that a record was last updated or changed. |
Provider Other Organization Name |
CRIMSON DOVE ABI |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Other Organization Name Type Code |
3 |
The first name of the authorized official. |
Provider First Line Business Practice Location Address |
214 BRECKENRIDGE LN STE 203 |
The middle name of the authorized official. |
Provider Business Practice Location Address City Name |
LOUISVILLE |
The title or position of the authorized official. |
Provider Business Practice Location Address State Name |
KY |
The 10-position telephone number of the authorized official. |
Provider Business Practice Location Address Postal Code |
402073879 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
5027424014 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
5027094264 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
1/31/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/5/2022 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
BLAIR |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
PERRY |
The first name of the authorized official. |
Authorized Official Title or Position |
OWNER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
5027424014 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
311ZA0620X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
320900000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
Y |
|
Parent Organization LBN |
CRIMSON DOVE COUNSELING SERVICES, INC. |
|
Parent Organization TIN |
|
|
Authorized Official Name Prefix Text |
MR. |
|
NPI Certification Date |
4/5/2022 |
|