| NPI | 1891349833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY HAGAN Owner 502-326-3011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-07-29 |