| NPI | 1548916810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN C MITCHELL Credentialing Agent 502-654-3927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-02-25 |