Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 171243 | KY |
Y | 103TC0700X | Clinical Psychologist | 171243 | KY |
N | 103G00000X | Clinical Psychologist | PSYPAT00222503 | KY |
N | 103TC0700X | Clinical Psychologist | PSYPAT00222503 | KY |
NPI | 1972972941 |
---|---|
Provider Name | Katie Thompson |
First Address | Elizabethtown, KY 42701-3650 |
Second Address | Bardstown, KY 40004-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 14/06/2018 |