=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376775668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH PSYCHOLOGY ASSOCIATES, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2009
-----------------------------------------------------
Last Update Date | 01/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E CHESTNUT ST SUITE 510
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-413-5228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8116
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40257-8116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-413-5228
-----------------------------------------------------
Fax | 502-413-5995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PSYCHOLOGIST
-----------------------------------------------------
Name | DR. BRIAN R MONSMA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 502-413-5228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number | 0867
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------