Provider Demographics
NPI:1578655650
Name:LITTLE PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:LITTLE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-525-4911
Mailing Address - Street 1:6900 HOUSTON RD
Mailing Address - Street 2:BUILDING 500, SUITE 11
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4884
Mailing Address - Country:US
Mailing Address - Phone:859-525-4911
Mailing Address - Fax:859-525-6446
Practice Address - Street 1:6900 HOUSTON RD
Practice Address - Street 2:BUILDING 500, SUITE 11
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4884
Practice Address - Country:US
Practice Address - Phone:859-525-4911
Practice Address - Fax:859-525-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7280Medicare ID - Type Unspecified