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General NPI Number Information
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NPI Number | 1871952978
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Entity Type | Individual
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Provider Name | BRUCE DWAIN ATHERTON J.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 4006 DUTCHMANS LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4704
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Country | US
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Telephone | 502-424-4452
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Fax | 502-896-8607
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Provider Business Mailing Address
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Address Line | 4006 DUTCHMANS LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4704
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Country | US
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Telephone | 502-424-4452
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Fax | 502-896-8607
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 81045
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License Number State | KY
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