Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 102L00000X | Psychologist | 130742 | KY |
Y | 103T00000X | Psychologist | 130742 | KY |
NPI | 1013102987 |
---|---|
Provider Name | Maria Allen-Jenkins |
First Address | Louisville, KY 40220-3100 |
Second Address | Louisville, KY 40220-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 12/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
609550001 | (05) | MD |
609550004 | (05) | MD |