Basic Information
| Provider Information | |||||||||
| NPI: | 1730317801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH PSYCHOLOGY ASSOCIATES, PSC | ||||||||
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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: | 101 CRESCENT AVE STE A | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402061512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024135228 | ||||||||
| FaxNumber: | 5024135995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | MONSMA | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5024135228 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0004X | 0867 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Health |
ID Information
| ID | Type | State | Issuer | Description | DQ6556 | 01 | KY | RR MEDICARE | OTHER | 7100112570 | 05 | KY | MEDICAID |