Individual
DR. TERI L MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 ABRAHAM FLEXNER WAY, 6TH FLOOR-PSYCHOLOGY DEPARTMENT, LOUISVILLE, KY 40202-3826
(502) 582-7484
(502) 582-7646
Mailing address
6801 DIXIE HWY, SUITE 130, LOUISVILLE, KY 40258-3913
(502) 582-7484
(502) 582-7646
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1509
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
05
—
7100230110 (JPG)
—
KY
Enumeration date
03/15/2007
Last updated
02/26/2013
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