| NPI | 1366655722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN YOUNG PORTER Owner 502-644-0007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 0722) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 0722) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 0722) | |
| 103TF0000X Psychologist, Family (Licence: KY 0722) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: KY 0722) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |