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General NPI Number Information
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NPI Number | 1386743037
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Entity Type | Organization
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Legal Business Name | KENTUCKIANA PSYCHOTHERAPY ASSOCIATES
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 9017 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40242
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Country | US
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Telephone | 502-499-9993
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Fax | 502-495-0758
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Provider Business Mailing Address
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Address Line | 9017 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40242
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Country | US
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Telephone | 502-499-9993
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Fax | 502-495-0758
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. MOHAMMAD A MIAN
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Credential | MD
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Telephone | 502-499-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 425
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License Number State | KY
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