Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | NOT ASSIGNED | KY |
NPI | 1134397706 |
---|---|
Provider Name | Lisa Cheney |
First Address | Elizabethtown, KY 42701-2525 |
Second Address | Elizabethtown, KY 42701-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 15/02/2008 |