| NPI | 1306201280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DON L. NANNY Administrator 502-896-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |