| NPI | 1639341126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BRUCE FANE Owner 270-393-9833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 1104) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2014-10-21 |