| NPI | 1235659806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W. STANLEY Credentialing 606-526-9005 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: KY 700188) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-06-28 |