Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | KY |
NPI | 1063032589 |
---|---|
Provider Name | Jarvis M Brookins |
First Address | Maysville, KY 41056 |
Second Address | Maysville, KY 41056-4105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2020 |
Last Update Date | 24/04/2020 |