| Total Spectrum Autism Services Llc | |
|
515 Maplewood Blvd Georgetown IN 47122-9261 | |
| (502) 767-9405 | |
| (812) 727-5522 |
| Full Name | Total Spectrum Autism Services Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 515 Maplewood Blvd, Georgetown, Indiana |
| Authorized Official Name and Position | Katerrell Leon Kennedy (CEO) |
| Authorized Official Contact | 5027679405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Spectrum Autism Services Llc 515 Maplewood Blvd Georgetown IN 47122-9261 Ph: (502) 767-9405 | Total Spectrum Autism Services Llc 515 Maplewood Blvd Georgetown IN 47122-9261 Ph: (502) 767-9405 |
| NPI Number | 1932643590 |
|---|---|
| Provider Enumeration Date | 12/15/2016 |
| Last Update Date | 12/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932643590 | NPI | - | NPPES |
| 1235558628 | Other | IN | COMMERCIAL |
| 1013002443 | Other | KY | COMMERCIAL |
| 1790917060 | Other | IN | COMMERCIAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39002390A (Indiana) | Secondary |
| 103TC0700X | Psychologist - Clinical | 129006 (Kentucky) | Primary |
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