Provider Demographics
NPI:1023594934
Name:AAFREEL, LLC DBA KENTUCKY PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:AAFREEL, LLC DBA KENTUCKY PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEL
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:859-200-1990
Mailing Address - Street 1:606 S DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9520
Mailing Address - Country:US
Mailing Address - Phone:859-200-1990
Mailing Address - Fax:
Practice Address - Street 1:606 S DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-9520
Practice Address - Country:US
Practice Address - Phone:859-200-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty