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761 Jefferson Pl Taylor Mill KY 41015-2233 | |
(360) 678-5151 | |
(360) 678-7676 |
Full Name | |
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Speciality | Psychiatry & Neurology - Psychiatry |
Location | 761 Jefferson Pl, Taylor Mill, Kentucky |
Authorized Official Name and Position | Ronald Telles (CEO) |
Authorized Official Contact | 3606787656 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3603 Seattle WA 98124-3603 Ph: (360) 678-7656 | 761 Jefferson Pl Taylor Mill KY 41015-2233 Ph: (360) 678-5151 |
NPI Number | 1740823780 |
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Provider Enumeration Date | 10/22/2019 |
Last Update Date | 10/24/2019 |
Identifier | Type | State | Issuer |
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1740823780 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |