| NPI | 1396260527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HAGAN Office Manager 502-326-3011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 21595) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 106H00000X Marriage & Family Therapist | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2022-07-21 |