Provider Demographics
NPI:1275842213
Name:EASTPOINT PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:EASTPOINT PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-245-7258
Mailing Address - Street 1:13804 LAKE POINT CIRCLE,
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4219
Mailing Address - Country:US
Mailing Address - Phone:502-245-7258
Mailing Address - Fax:502-245-7259
Practice Address - Street 1:13804 LAKE POINT CIRCLE,
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4219
Practice Address - Country:US
Practice Address - Phone:502-245-7258
Practice Address - Fax:502-245-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty