Provider Demographics
NPI:1386743037
Name:KENTUCKIANA PSYCHOTHERAPY ASSOCIATES
Entity type:Organization
Organization Name:KENTUCKIANA PSYCHOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-499-9993
Mailing Address - Street 1:9017 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242
Mailing Address - Country:US
Mailing Address - Phone:502-499-9993
Mailing Address - Fax:502-495-0758
Practice Address - Street 1:9017 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242
Practice Address - Country:US
Practice Address - Phone:502-499-9993
Practice Address - Fax:502-495-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82004250Medicaid
KY82004250Medicaid