Provider Demographics
NPI:1801846647
Name:UREY, JON RUSSELL (PHD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:RUSSELL
Last Name:UREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 RING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7945
Mailing Address - Country:US
Mailing Address - Phone:270-763-9577
Mailing Address - Fax:270-763-6938
Practice Address - Street 1:2608 RING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7945
Practice Address - Country:US
Practice Address - Phone:270-763-9577
Practice Address - Fax:270-763-6938
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical