Provider Demographics
NPI:1790358760
Name:NEURODIVERSITY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:NEURODIVERSITY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M NEWLAND
Authorized Official - Last Name:PSY.D.
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-333-2687
Mailing Address - Street 1:713 MILLPOND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1570
Mailing Address - Country:US
Mailing Address - Phone:859-780-3805
Mailing Address - Fax:
Practice Address - Street 1:713 MILLPOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1570
Practice Address - Country:US
Practice Address - Phone:859-780-3805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100747780Medicaid