| NPI | 1598402117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WARREN Director Of Credentialing 502-400-8480 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-05-16 |