| NPI | 1720762115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON FORD CEO 859-300-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-01-24 |