| NPI | 1811324122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN ANDERSON President 502-272-9718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 1732) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1723) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2021-06-29 |