Provider Demographics
NPI:1114155272
Name:MONSMA, BRIAN R (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:MONSMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8116
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-8116
Mailing Address - Country:US
Mailing Address - Phone:502-413-5228
Mailing Address - Fax:502-413-5995
Practice Address - Street 1:8007 LYNDON CENTRE WAY, SUITE # 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-690-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY680011822OtherRR MEDICARE
KY7100101660Medicaid
KY7100101660Medicaid