| NPI | 1457999096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST Syst VP Of Mngd Care & Payor Strat 502-272-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist Clinical | |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2021-09-22 |