# NORTON CHILDREN'S MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Norton Children's Psychiatry and Psychology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275174625
- **Authorized official:** MS. SHELLEY GAST (SYST VP MNGD CARE & PAYOR STRAT)
- **Authorized official phone:** (502) 272-5335

## Contact information

- **Practice address:** 4803 OLYMPIA PARK PLZ STE 1100, LOUISVILLE, KY 40241-3068
- **Practice address phone:** (502) 272-5336
- **Practice address fax:** (502) 272-5339
- **Mailing address:** PO BOX 766879, CHICAGO, IL 60677-6879
- **Mailing address phone:** (502) 272-5336
- **Mailing address fax:** (502) 272-5339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/07/2019
- **Last updated:** 09/22/2021