Individual
DR. JACK TEEPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
455 S 4TH ST STE 842, LOUISVILLE, KY 40202-2576
(502) 584-7216
(502) 585-5373
Mailing address
455 S 4TH ST STE 842, LOUISVILLE, KY 40202-2576
(502) 584-7216
(502) 585-5373
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
710
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89007108
—
KY
Enumeration date
08/29/2006
Last updated
07/08/2007
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