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General NPI Number Information
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NPI Number | 1619061470
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Entity Type | Organization
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Legal Business Name | BLUEGRASS HEALTH PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 2220 YOUNG DRIVE
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City | LEXINGTON
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State | KY
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Zip | 40505-4219
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Country | US
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Telephone | 859-277-1008
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Fax | 859-277-1083
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Provider Business Mailing Address
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Address Line | 4101 TATES CREEK CTR DR SUITE 150, PMB 123
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City | LEXINGTON
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State | KY
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Zip | 40517-3066
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Country | US
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Telephone | 859-277-1008
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Fax | 859-277-1083
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JONATHAN D COLE
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Credential | PH.D.
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Telephone | 859-277-1008
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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 | 1200
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1200
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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