Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | KY-1246 | KY |
Y | 103T00000X | Psychologist | KY-1246 | KY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | KY-1246 | KY |
N | 103TC1900X | Counseling Psychologist | KY-1246 | KY |
N | 103TM1800X | Intellectual & Developmental Disabilities | KY-1246 | KY |
N | 103TP2701X | Group Psychotherapist | KY-1246 | KY |
NPI | 1114322120 |
---|---|
Provider Name | Sandra Medley |
First Address | Somerset, KY 42501-2935 |
Second Address | Somerset, KY 42501-2935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 03/11/2014 |