| NPI | 1588347157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA GAINES Partner/Co Owner 502-644-9162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QI0500X Clinic/Center Infusion Therapy | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2023-08-10 |