Provider Demographics
NPI:1104088038
Name:GOOD SHEPHERD INSTITUTE, INC.
Entity type:Organization
Organization Name:GOOD SHEPHERD INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-371-2800
Mailing Address - Street 1:7103 TURFWAY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2094
Mailing Address - Country:US
Mailing Address - Phone:859-371-2800
Mailing Address - Fax:859-371-2823
Practice Address - Street 1:7103 TURFWAY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2094
Practice Address - Country:US
Practice Address - Phone:859-371-2800
Practice Address - Fax:859-371-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0819789Medicaid
KY8900063200Medicaid
KY9402OtherMEDICARE GROUP NUMBER
KY0940201Medicare PIN