| NPI | 1003520701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WARREN Director Of Credentialing 502-381-3338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |