Provider Demographics
NPI:1477748846
Name:JEAN A. DETERS, PSY.D., PLLC
Entity type:Organization
Organization Name:JEAN A. DETERS, PSY.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-331-6525
Mailing Address - Street 1:2128 CHAMBER CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT. MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-331-6525
Mailing Address - Fax:859-331-6526
Practice Address - Street 1:2128 CHAMBER CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FT. MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-6525
Practice Address - Fax:859-331-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty