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General NPI Number Information
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NPI Number | 1811585227
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Entity Type | Organization
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Legal Business Name | DRAGONFLY PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 01/02/2021
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Last Update Date | 01/02/2021
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Provider Practice Location Address
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Address Line | 9403 HOBBLEBUSH ST
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City | PROSPECT
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State | KY
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Zip | 40059-7667
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Country | US
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Telephone | 502-230-7599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 300
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City | PROSPECT
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State | KY
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Zip | 40059-0300
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Country | US
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Telephone | 502-230-7599
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Fax |
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Authorized Official
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Title or Position | OWNER / PSYCHOLOGIST
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Name | DR. BARBARA BEAUCHAMP
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Credential |
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Telephone | 502-230-7599
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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 |
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License Number State |
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