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2128 Chamber Center Drive Ft. Mitchell KY 41017 | |
| (859) 331-6525 | |
| (859) 331-6526 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2128 Chamber Center Drive, Ft. Mitchell, Kentucky |
| Authorized Official Name and Position | Jean A Deters (SINGLE MEMBER) |
| Authorized Official Contact | 8593316525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2128 Chamber Center Drive Ft. Mitchell KY 41017 Ph: (859) 331-6525 | 2128 Chamber Center Drive Ft. Mitchell KY 41017 Ph: (859) 331-6525 |
| NPI Number | 1477748846 |
|---|---|
| Provider Enumeration Date | 09/10/2007 |
| Last Update Date | 09/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477748846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1391 (Kentucky) | Primary |