Healthcare Provider Details

I. General information

NPI: 1659593630
Provider Name (Legal Business Name): LEA JEAN PERRITT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 WEST VINE STREET SUITE 1904
LEXINGTON KY
40507-1834
US

IV. Provider business mailing address

369 WEST VINE STREET SUITE 1904
LEXINGTON KY
40507-1834
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-9819
  • Fax: 502-564-6050
Mailing address:
  • Phone: 859-253-9819
  • Fax: 502-564-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0521
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: