Individual
TABITHA BURKHART-WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPP
Contact information
Practice address
3125 TIMBERNECK CV, LEXINGTON, KY 40509-8539
(859) 200-1650
Mailing address
3125 TIMBERNECK CV, LEXINGTON, KY 40509-8539
(859) 200-1650
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0105
KY
Other
Enumeration date
04/01/2014
Last updated
04/01/2014
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