Healthcare Provider Details

I. General information

NPI: 1962335034
Provider Name (Legal Business Name): HMC PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 QUEBEC WAY
LEXINGTON KY
40515-4626
US

IV. Provider business mailing address

161 QUEBEC WAY
LEXINGTON KY
40515-4626
US

V. Phone/Fax

Practice location:
  • Phone: 606-694-6466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JARED DILLOW
Title or Position: MANAGING MEMBER
Credential: LPP
Phone: 606-694-6466