Provider Demographics
NPI:1407099724
Name:OLDHAM COUNTY ASSESSMENT & PSYCHOLOGICAL SERVICE
Entity Type:Organization
Organization Name:OLDHAM COUNTY ASSESSMENT & PSYCHOLOGICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-243-4280
Mailing Address - Street 1:6402 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9508
Mailing Address - Country:US
Mailing Address - Phone:502-243-4280
Mailing Address - Fax:502-243-4279
Practice Address - Street 1:6402 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9508
Practice Address - Country:US
Practice Address - Phone:502-243-4280
Practice Address - Fax:502-243-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1469103T00000X
KY392872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty