| NPI | 1558122044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH ALTSTADT Provider Enrollment Specialist 502-394-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-01-22 |