Healthcare Provider Details

I. General information

NPI: 1669238903
Provider Name (Legal Business Name): KENTUCKY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 FAWN VALLEY RD
CORBIN KY
40701-7473
US

IV. Provider business mailing address

PO BOX 976
CORBIN KY
40702-0976
US

V. Phone/Fax

Practice location:
  • Phone: 606-383-0780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ALEX JONES
Title or Position: ADMINISTRATION
Credential:
Phone: 606-383-0780