Basic Information
| Provider Information | |||||||||
| NPI: | 1477018885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FROST | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 LYNDONWOODS CIR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402226846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029319269 | ||||||||
| FaxNumber: | 5024230643 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 CRANES ROOST COURT | ||||||||
| Address2: | COMMUNICARE,INC. | ||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427013650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707652605 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 101654 | KY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.