Black, John W

Black, John W is an individual health care provider with primary practice located at 110 Roach St , Georgetown KY 40324-9393. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Black, John W can be contacted via phone (859) 253-1686.

Contact Information

Primary practice address
110 Roach St Georgetown KY 40324-9393
Phone: (859) 253-1686
Fax: (859) 254-2743
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 423 Kentucky

Profile Details

NPI number 1457401945
LBN Legal business name Black, John W
Credentials MS, LPA
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457401945 NPPES
Kentucky MEDICAID 30615058

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