| NPI | 1992267223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA L CLEMENS Credentialing Coordinator 502-489-4302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2019-04-04 |