| NPI | 1760866891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR AO 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2025-06-26 |