Healthcare Provider Details

I. General information

NPI: 1740442441
Provider Name (Legal Business Name): TIMOTHY J. NORTH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 210
LOUISVILLE KY
40218
US

IV. Provider business mailing address

3430 NEWBURG RD STE 210
LOUISVILLE KY
40218-2458
US

V. Phone/Fax

Practice location:
  • Phone: 502-454-8800
  • Fax: 502-736-0140
Mailing address:
  • Phone: 502-454-8800
  • Fax: 502-736-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number636
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: