| NPI | 1215593231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEEMIA HURST SHAW Clinical Director 502-443-7271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-05-15 |