MEDICARE: DRAGONFLY PSYCHOLOGICAL ASSOCIATES

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

General Provider Information

NPI Number	:	1811585227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY PSYCHOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-0300
Country	:	US
Telephone Number	:	502-230-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	9403 HOBBLEBUSH ST
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-7667
Country	:	US
Telephone Number	:	502-230-7599
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PSYCHOLOGIST
Name	:	DR. BARBARA BEAUCHAMP
Credential	:
Telephone Number	:	502-230-7599

Provider Enumeration Date	:	01/02/2021
Last Update Date	:	01/02/2021

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