| NPI | 1568480408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY J BLEIDT Clinical Psychologist 502-897-9737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 0414) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-08-22 |