Provider Demographics
NPI:1265893598
Name:DENNIS BUCHHOLZ PHD AND ASSOCIATES
Entity type:Organization
Organization Name:DENNIS BUCHHOLZ PHD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-561-0952
Mailing Address - Street 1:1161 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1711
Mailing Address - Country:US
Mailing Address - Phone:502-561-0952
Mailing Address - Fax:
Practice Address - Street 1:1161 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1711
Practice Address - Country:US
Practice Address - Phone:502-561-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY482261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89004824Medicaid
KY3007101Medicare UPIN
KY89004824Medicaid