Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TH0004X | Health Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1194374207 |
---|---|
Provider Name | Dr. John Lee Cecil |
First Address | Harold, KY 41635-7008 |
Second Address | Harold, KY 41635-7008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NONE (01) |