Organization
TOTAL SPECTRUM AUTISM SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATERRELL LEON KENNEDY (CEO)
(502) 767-9405
Entity
Organization
Contact information
Practice address
515 MAPLEWOOD BLVD, GEORGETOWN, IN 47122-9261
(502) 767-9405
(812) 727-5522
Mailing address
515 MAPLEWOOD BLVD, GEORGETOWN, IN 47122-9261
(502) 767-9405
(812) 727-5522
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39002390A
IN
103TC0700X
Clinical Psychologist
Primary
129006
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013002443
COMMERCIAL
KY
01
—
1235558628
COMMERCIAL
IN
01
—
1790917060
COMMERCIAL
IN
Enumeration date
12/15/2016
Last updated
12/15/2016
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