Healthcare Provider Details

I. General information

NPI: 1891740635
Provider Name (Legal Business Name): KAREL DISPONETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N 5TH ST SUITE 11
BARDSTOWN KY
40004-1449
US

IV. Provider business mailing address

6274 OLD BLOOMFIELD RD
BLOOMFIELD KY
40008-7602
US

V. Phone/Fax

Practice location:
  • Phone: 502-507-9765
  • Fax: 502-348-0121
Mailing address:
  • Phone: 502-490-0198
  • Fax: 502-348-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0051
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2007-67
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: