Provider Demographics
NPI:1114305372
Name:OLIVIA AKRIDGE
Entity Type:Organization
Organization Name:OLIVIA AKRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SUPPORTS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:AKRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:270-601-1277
Mailing Address - Street 1:2391 SIR BARTON WAY APT 1220
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2563
Mailing Address - Country:US
Mailing Address - Phone:270-601-1277
Mailing Address - Fax:
Practice Address - Street 1:1035 STRADER DR STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4086
Practice Address - Country:US
Practice Address - Phone:859-899-9200
Practice Address - Fax:859-899-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-14-16048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty