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General NPI Number Information
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NPI Number | 1316344534
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Entity Type | Organization
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Legal Business Name | THE PARENT-CHILD WELLNESS PLACE
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 1169 EASTERN PKWY STE 3438
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-553-0534
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Fax |
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PKWY STE 3438
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-553-0534
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PSYCHOLOGIST
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Name | DR. MELISSA F HAYDEN
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Credential | PYS.D.
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Telephone | 502-553-0534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1638
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License Number State | KY
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