Healthcare Provider Details

I. General information

NPI: 1093920894
Provider Name (Legal Business Name): DAN FLORELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/01/2018
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: 859-624-2454
  • Fax: 859-624-2454
Mailing address:
  • Phone: 859-624-2454
  • Fax: 859-624-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number129219
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: