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General NPI Number Information
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NPI Number | 1386964658
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Entity Type | Organization
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Legal Business Name | LOUISVILLE NEUROPSYCHOLOGY LLC
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 13293 OBANNON STATION WAY
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City | LOUISVILLE
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State | KY
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Zip | 40223-4188
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Country | US
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Telephone | 502-254-1001
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Fax | 502-254-1004
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Provider Business Mailing Address
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Address Line | 13293 OBANNON STATION WAY
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City | LOUISVILLE
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State | KY
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Zip | 40223-4188
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Country | US
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Telephone | 502-254-1001
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Fax | 502-254-1004
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST / PRESIDENT
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Name | DR. MICHAEL H CECIL
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Credential | PSYD
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Telephone | 502-254-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1226
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License Number State | KY
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