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General NPI Number Information
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NPI Number | 1609762004
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Entity Type | Individual
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Provider Name | DAMON TICHENOR JR. PSYD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 120 PROSPEROUS PL STE 115
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City | LEXINGTON
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State | KY
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Zip | 40509-1866
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Country | US
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Telephone | 859-368-0609
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PROVINCIAL WAY APT 2
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City | BEREA
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State | KY
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Zip | 40403-7019
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Country | US
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Telephone | 859-693-1053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 295085
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License Number State | KY
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