Doctor Name: | MRS. DESIREE MILNE ANTONSON |
NPI Number: | 1316139587 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S LPA |
License Number: | KY-0988 |
Business Practice Address: | 300 Foxglove Dr Mount Sterling, KY - 403539769 |
Business Phone Number: | 8594982135 |
Business Fax Number: | |
Mailing Address: | 1212 Bath Ave, ASHLAND |
State: | KY |
Postal Code: | 411012696 |
Phone Number: | 6063298588 |
Fax Number: | |
NPI Enumeration Date: | 08/13/2007 |
NPI Last Update Date: | 11/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | KY-0988 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |