Provider Demographics
NPI:1164435541
Name:PEDIATRIC PSYCHOLOGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PEDIATRIC PSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-429-5431
Mailing Address - Street 1:9700 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2236
Mailing Address - Country:US
Mailing Address - Phone:502-429-5431
Mailing Address - Fax:502-429-5495
Practice Address - Street 1:9700 PARK PLAZA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2236
Practice Address - Country:US
Practice Address - Phone:502-429-5431
Practice Address - Fax:502-429-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty