Basic Information
| Provider Information | |||||||||
| NPI: | 1730269093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGH | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 VERSAILLES RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593230666 | ||||||||
| FaxNumber: | 8593231123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 VERSAILLES RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593230666 | ||||||||
| FaxNumber: | 8593231123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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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 | 103G00000X | 23847 | TX | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | 1446 | KY | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | TX | MEDICAID |