| NPI | 1023445913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA L CLEMENS Credentialing Coordinator 502-489-4302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2014-03-13 |