Healthcare Provider Details

I. General information

NPI: 1841422805
Provider Name (Legal Business Name): ANDREA HALE STRAIT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA DAWN HALES PHD

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LEXINGTON RD
RICHMOND KY
40475-1059
US

IV. Provider business mailing address

1421 LEXINGTON RD
RICHMOND KY
40475-1059
US

V. Phone/Fax

Practice location:
  • Phone: 859-358-6791
  • Fax: 859-624-2454
Mailing address:
  • Phone: 859-358-6791
  • Fax: 859-624-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberKY-1463
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: