Healthcare Provider Details

I. General information

NPI: 1366112823
Provider Name (Legal Business Name): CARDINAL BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 11/15/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DISHMAN LANE EXT APT C
BOWLING GREEN KY
42104-4072
US

IV. Provider business mailing address

719 DISHMAN LANE EXT APT C
BOWLING GREEN KY
42104-4072
US

V. Phone/Fax

Practice location:
  • Phone: 270-202-8669
  • Fax: 270-200-8781
Mailing address:
  • Phone: 270-202-8669
  • Fax: 270-200-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOELLEN MARION
Title or Position: PRESIDENT
Credential:
Phone: 270-202-8669