Organization
BLUEGRASS HEALTH PSYCHOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN D COLE PH.D. (PRESIDENT/OWNER)
(859) 277-1008
Entity
Organization
Contact information
Practice address
2220 YOUNG DRIVE, LEXINGTON, KY 40505-4219
(859) 277-1008
(859) 277-1083
Mailing address
4101 TATES CREEK CTR DR, SUITE 150, PMB 123, LEXINGTON, KY 40517-3066
(859) 277-1008
(859) 277-1083
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1200
KY
103TC0700X
Clinical Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
1200
KY
103TH0100X
Health Service Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100071880
—
KY
Enumeration date
10/03/2006
Last updated
08/09/2022
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