Healthcare Provider Details

I. General information

NPI: 1265239602
Provider Name (Legal Business Name): CC BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 HOLLY GROVE RD
CORBIN KY
40701-4427
US

IV. Provider business mailing address

244 HOLLY GROVE RD
CORBIN KY
40701-4427
US

V. Phone/Fax

Practice location:
  • Phone: 606-620-4404
  • Fax: 606-620-4410
Mailing address:
  • Phone: 606-620-4404
  • Fax: 606-620-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: CYMBRE LIN PATRICK
Title or Position: OWNER
Credential: LCSW
Phone: 606-620-4404