MEDICARE: DR. ALLISON ELIZABETH FROM PSY.D.

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	103TC0700X	Clinical Psychologist	1234	KY

General Provider Information

NPI Number	:	1548231954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON ELIZABETH FROM PSY.D.

Provider Business Mailing Address
First Line	:	2002 KENILWORTH PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1514
Country	:	US
Telephone Number	:	502-459-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1169 EASTERN PKWY
Second Line	:	MEDICAL ARTS BUILDING SUITE 1147
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1417
Country	:	US
Telephone Number	:	502-451-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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