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General NPI Number Information
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NPI Number | 1629302633
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Entity Type | Individual
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Provider Name | BROOKE CHRISTIAN SHRINER PHD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 4912 US HIGHWAY 42 SUITE 104
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City | LOUISVILLE
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State | KY
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Zip | 40222-6349
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Country | US
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Telephone | 502-429-8640
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Fax | 502-426-2283
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST SUITE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1434
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Country | US
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Telephone | 502-429-8640
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Fax | 502-426-2283
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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 | 130741
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License Number State | KY
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