| NPI | 1912228891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEENA OMBRES Privacy Officer 502-394-2387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2010-06-15 |