| NPI | 1154949469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY HICKS Owner 502-262-2887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |