John W Balchunas, PA
Individual provider Active NPI Clinical Psychologist · Bowling Green, KY
NPI 1477565240 · NPPES record last updated Aug 2, 2010
Key facts
- NPI
- 1477565240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 0743 (KY)
- Practice address
- 1215 High St
Bowling Green, KY 42101-2541 - Phone
- (270) 782-1116
- Fax
- (270) 782-9108
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0743 | KY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chestnut Park Professionals, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0743 | KY | Yes |
Addresses
Primary practice location
1215 High St
Bowling Green, KY 42101-2541
Mailing address
1215 High St
Bowling Green, KY 42101-2541
Phone (270) 782-1116
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30610026 | Medicaid | KY |
Other providers in Bowling Green, KY
- Kaitlyn M. Baker
- Kathy Davis Baker
- Mary Jo D. Baker
- Terry Randall Baker
- Balance Therapeutic Care, Counseling Services LLC
- Jonathon Baldwin
- Kenneth Grant Bale
- Margaret Louise Ballard
- Olivia Ballard
- Khrystin Ballenger
All providers in Bowling Green, KY · Clinical Psychologist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.