| Deshields Behavioral Wellness, Inc. | |
|
2515 Gardiner Ln Louisville KY 40205-3003 | |
| (502) 681-7330 | |
| (502) 489-5552 |
| Full Name | Deshields Behavioral Wellness, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 2515 Gardiner Ln, Louisville, Kentucky |
| Authorized Official Name and Position | Katie Beth Deshields (PRESIDENT) |
| Authorized Official Contact | 5026817330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deshields Behavioral Wellness, Inc. 2515 Gardiner Ln Louisville KY 40205-3003 Ph: (502) 681-7330 | Deshields Behavioral Wellness, Inc. 2515 Gardiner Ln Louisville KY 40205-3003 Ph: (502) 681-7330 |
| NPI Number | 1013371699 |
|---|---|
| Provider Enumeration Date | 04/08/2016 |
| Last Update Date | 04/08/2016 |
| Medicare PECOS PAC ID | 7416256581 |
|---|---|
| Medicare Enrollment ID | O20160425001946 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013371699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 216350 (Kentucky) | Primary |
| Provider Name | Katie B Deshields |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639320344 PECOS PAC ID: 7416251434 Enrollment ID: I20160210002856 |
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