Provider Demographics
NPI:1902458201
Name:SISU MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SISU MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:502-709-5386
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-0809
Mailing Address - Country:US
Mailing Address - Phone:502-709-5386
Mailing Address - Fax:502-653-7575
Practice Address - Street 1:3044 BRECKENRIDGE LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2193
Practice Address - Country:US
Practice Address - Phone:502-709-5386
Practice Address - Fax:502-653-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty