| Organization Name: | JEAN A. DETERS, PSY.D., PLLC |
| NPI Number: | 1477748846 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEAN A DETERS (SINGLE MEMBER) |
| Mailing Address: | 2128 Chamber Center Drive Ft. Mitchell |
| State: | KY US |
| Postal Code: | 41017 |
| Phone Number: | 8593316525 |
| Fax Number: | 8593316526 |
| NPI Enumeration Date: | 09/10/2007 |
| NPI Last Update Date: | 09/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |