MEDICARE: FOUR POINTS BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235722695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR POINTS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	815 N GAY ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N GAY ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1751
Country	:	US
Telephone Number	:	740-504-6846
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KC MONTOYA
Credential	:	LISW
Telephone Number	:	740-504-6846

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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