Healthcare Provider Details

I. General information

NPI: 1407099724
Provider Name (Legal Business Name): OLDHAM COUNTY ASSESSMENT & PSYCHOLOGICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 W HIGHWAY 146
CRESTWOOD KY
40014-9508
US

IV. Provider business mailing address

6402 W HIGHWAY 146
CRESTWOOD KY
40014-9508
US

V. Phone/Fax

Practice location:
  • Phone: 502-243-4280
  • Fax: 502-243-4279
Mailing address:
  • Phone: 502-243-4280
  • Fax: 502-243-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1469
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39287
License Number StateKY

VIII. Authorized Official

Name: JEFFREY L. HICKS
Title or Position: PRACTICE MANAGER
Credential: PHD
Phone: 502-243-4280