Healthcare Provider Details

I. General information

NPI: 1497665053
Provider Name (Legal Business Name): INTO ACTION BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S MAIN ST STE 104
CORBIN KY
40701-1891
US

IV. Provider business mailing address

171 NOLAN DR
CORBIN KY
40701-6900
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-3176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON PAYNE
Title or Position: CEO
Credential:
Phone: 859-797-3176