| NPI | 1104323252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY HICKS Owner 502-262-2887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2024-07-22 |