Provider Demographics
NPI:1083760813
Name:LIND, ROBERT MICHAEL (PSYD CLINICAL PSYCHO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:LIND
Suffix:
Gender:M
Credentials:PSYD CLINICAL PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3424
Mailing Address - Country:US
Mailing Address - Phone:859-341-9888
Mailing Address - Fax:859-817-9144
Practice Address - Street 1:226 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3424
Practice Address - Country:US
Practice Address - Phone:859-341-9888
Practice Address - Fax:859-817-9144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
571219401OtherEIN NUMBER