Provider Demographics
NPI:1376907949
Name:PROFESSIONAL ASSESSMENT & THERAPEUTIC SERVICES PSC
Entity Type:Organization
Organization Name:PROFESSIONAL ASSESSMENT & THERAPEUTIC SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:270-317-4198
Mailing Address - Street 1:920 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1400
Mailing Address - Country:US
Mailing Address - Phone:270-317-4198
Mailing Address - Fax:
Practice Address - Street 1:1161 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1711
Practice Address - Country:US
Practice Address - Phone:502-561-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty