Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 0594 | KY |
Y | 103TC0700X | Clinical Psychologist | 0594 | KY |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1144626458 |
---|---|
Provider Name | Mrs. Kristi Pack |
First Address | Prestonsburg, KY 41653-1343 |
Second Address | Prestonsburg, KY 41653-1343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 13/11/2014 |