Organization
PPL THERAPEUTIC SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY HICKS PSYCHOLOGIST (OWNER)
(502) 262-2887
Entity
Organization
Contact information
Practice address
8206 HIGHVIEW CT, CRESTWOOD, KY 40014-8105
(502) 262-2887
(502) 243-9517
Mailing address
8206 HIGHVIEW CT, CRESTWOOD, KY 40014-8105
(502) 262-2887
(502) 243-9517
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100530170
—
KY
05
—
7100531350
—
KY
05
—
7100536860
—
KY
05
—
7100589000
—
KY
Enumeration date
04/06/2018
Last updated
07/22/2024
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