| NPI | 1902377864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY FITCH Business Manager 606-309-1291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 1041C0700X Social Worker, Clinical | |
| 101Y00000X Counselor | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TH0004X Psychologist, Health | |
| 103TH0100X Psychologist, Health Service | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2022-09-08 |