Provider Demographics
NPI:1396963690
Name:AMEND, EDWARD R (PSYD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:AMEND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical