| NPI | 1114681681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE SEPANEK Credentialing Manager 502-813-4415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2024-02-27 |