MEDICARE: JOHN ADAM BARMORE LICENSED PSYCHOLOGICAL PRACTITIONER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0028	KY

General Provider Information

NPI Number	:	1184048316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN ADAM BARMORE LICENSED PSYCHOLOGICAL PRACTITIONER LLC

Provider Business Mailing Address
First Line	:	1310 S 1ST ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 S 1ST ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2302
Country	:	US
Telephone Number	:	502-387-3891
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGICAL PRACTITIONER
Name	:	JOHN ADAM BARMORE
Credential	:	LPP
Telephone Number	:	502-387-3891

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/07/2014

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