Healthcare Provider Details

I. General information

NPI: 1871088369
Provider Name (Legal Business Name): HOPE BEHAVIORAL SERVIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 S DIXON RD STE B
KOKOMO IN
46902-5644
US

IV. Provider business mailing address

3821 RED BUD LN
KOKOMO IN
46902-4382
US

V. Phone/Fax

Practice location:
  • Phone: 765-210-1284
  • Fax: 765-319-0605
Mailing address:
  • Phone: 765-210-1284
  • Fax: 765-319-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIN

VIII. Authorized Official

Name: BEVERLY FORREY
Title or Position: OWNER
Credential:
Phone: 765-210-1284