Basic Information
| Provider Information | |||||||||
| NPI: | 1114155272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONSMA | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8116 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402578116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024135228 | ||||||||
| FaxNumber: | 5024135995 | ||||||||
| Practice Location | |||||||||
| Address1: | 8007 LYNDON CENTRE WAY, SUITE # 101 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0867 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.