| NPI | 1528254265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHIL PACK Psychologist 606-788-0406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KY 0019) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2007-10-17 |