Provider Demographics
NPI:1699942292
Name:STORY, JOHN ERVIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERVIN
Last Name:STORY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3212
Mailing Address - Country:US
Mailing Address - Phone:859-533-9531
Mailing Address - Fax:
Practice Address - Street 1:704 SPRING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3624
Practice Address - Country:US
Practice Address - Phone:859-277-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical