Healthcare Provider Details

I. General information

NPI: 1811548316
Provider Name (Legal Business Name): HOPE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 BUTTERMILK PIKE STE 200
CRESCENT SPRINGS KY
41017-1696
US

IV. Provider business mailing address

103 FOX MEADOW RUN
JUPITER FL
33458-5504
US

V. Phone/Fax

Practice location:
  • Phone: 859-869-2023
  • Fax: 561-401-9196
Mailing address:
  • Phone: 859-250-6898
  • Fax: 561-401-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORI BETH MANGAN
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 859-869-2023