| Doctor Name: | MARK A ETSCHEIDT |
| NPI Number: | 1003839010 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 783 |
| Business Practice Address: | 740 S Limestone Lexington, KY - 405360001 |
| Business Phone Number: | 8593235956 |
| Business Fax Number: | |
| Mailing Address: | 2333 Alumni Park Plz, Suite 200 LEXINGTON |
| State: | KY |
| Postal Code: | 405174012 |
| Phone Number: | 8592577910 |
| Fax Number: | |
| NPI Enumeration Date: | 07/25/2006 |
| NPI Last Update Date: | 04/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 783 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |