Individual
JAY DEITERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
Mailing address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PSYPST00213906
KY
Other
Enumeration date
06/16/2015
Last updated
06/16/2015
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