Individual
MARK A ETSCHEIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
740 S LIMESTONE, LEXINGTON, KY 40536-0001
(859) 323-5956
Mailing address
2333 ALUMNI PARK PLZ, SUITE 200, LEXINGTON, KY 40517-4012
(859) 257-7910
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
783
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89007835
—
KY
Enumeration date
07/25/2006
Last updated
04/14/2008
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