| NPI | 1417266578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON KELLER Director 502-322-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 1548) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2010-10-06 |