Basic Information
Provider Information | |||||||||
NPI: | 1316184146 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEALE | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KUHN | ||||||||
OtherFirstName: | ELIZABETH | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2257 | ||||||||
Address2: |   | ||||||||
City: | CHESTERTON | ||||||||
State: | IN | ||||||||
PostalCode: | 463040357 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2199268320 | ||||||||
FaxNumber: | 2199263524 | ||||||||
Practice Location | |||||||||
Address1: | 421 BENJAMIN LANE STE 202 | ||||||||
Address2: |   | ||||||||
City: | LOUISVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 402220000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5026908024 | ||||||||
FaxNumber: | 5026908090 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/15/2009 | ||||||||
LastUpdateDate: | 05/26/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7235 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 129241 | KY | Y |   | Behavioral Health & Social Service Providers | Psychologist |   | 103T00000X | 4062 | NC | N |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.