Healthcare Provider Details

I. General information

NPI: 1932231735
Provider Name (Legal Business Name): PAUL ANTHONY EBBEN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PROGRESS DR SUITE B
FRANKFORT KY
40601-8695
US

IV. Provider business mailing address

106 PROGRESS DR SUITE B
FRANKFORT KY
40601-8695
US

V. Phone/Fax

Practice location:
  • Phone: 502-848-0201
  • Fax: 502-848-0203
Mailing address:
  • Phone: 502-848-0201
  • Fax: 502-848-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberKY0975
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: