Healthcare Provider Details

I. General information

NPI: 1275924615
Provider Name (Legal Business Name): UK LPP GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6021
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG COLLINS
Title or Position: SR VP HEALTH AFFAIRS / CFO
Credential:
Phone: 859-257-1773