Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0072 | KY |
Y | 103TC0700X | Clinical Psychologist | 0072 | KY |
NPI | 1003948191 |
---|---|
Provider Name | Mr. James M Moughan |
First Address | Lexington, KY 40511-1217 |
Second Address | Lexington, KY 40511-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30615058 | (05) | KY |