| NPI | 1225451024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KRUER Operations Manager 502-895-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2015-06-02 |