Provider Demographics
NPI:1740408095
Name:AMEND PSYCHOLOGICAL SERVICES, PSC
Entity Type:Organization
Organization Name:AMEND PSYCHOLOGICAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-269-6465
Mailing Address - Street 1:1025 DOVE RUN RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3588
Mailing Address - Country:US
Mailing Address - Phone:859-269-6465
Mailing Address - Fax:859-269-6401
Practice Address - Street 1:1025 DOVE RUN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3588
Practice Address - Country:US
Practice Address - Phone:859-269-6465
Practice Address - Fax:859-269-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1067, OH-5037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty