| NPI | 1407099724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY L. HICKS Practice Manager 502-243-4280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 1469) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 39287) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2009-04-16 |