| NPI | 1750252755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Director Provider Enrollment 502-394-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |