| NPI | 1366879025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PAUL SULLIVAN Owner 502-451-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 21704) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2020-01-09 |