Provider Demographics
NPI:1245498872
Name:MINDPSI: SCHOOL PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:MINDPSI: SCHOOL PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLORELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-358-6791
Mailing Address - Street 1:1421 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1059
Mailing Address - Country:US
Mailing Address - Phone:859-358-6791
Mailing Address - Fax:859-624-2454
Practice Address - Street 1:1421 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1059
Practice Address - Country:US
Practice Address - Phone:859-358-6791
Practice Address - Fax:859-624-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000676498OtherANTHEM PIN
KYP100027058Medicare PIN