| NPI | 1669907994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM PETRAE JOHNSON Owner 859-312-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: KY 3292) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-04-24 |