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General NPI Number Information
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NPI Number | 1407099724
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Entity Type | Organization
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Legal Business Name | OLDHAM COUNTY ASSESSMENT & PSYCHOLOGICAL SERVICE
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 6402 W HIGHWAY 146
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City | CRESTWOOD
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State | KY
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Zip | 40014-9508
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Country | US
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Telephone | 502-243-4280
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Fax | 502-243-4279
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Provider Business Mailing Address
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Address Line | 6402 W HIGHWAY 146
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City | CRESTWOOD
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State | KY
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Zip | 40014-9508
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Country | US
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Telephone | 502-243-4280
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Fax | 502-243-4279
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JEFFREY L. HICKS
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Credential | PHD
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Telephone | 502-243-4280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 39287
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1469
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License Number State | KY
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