Healthcare Provider Details

I. General information

NPI: 1609385236
Provider Name (Legal Business Name): ANNA BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 HALLS HILL RD
CRESTWOOD KY
40014-9523
US

IV. Provider business mailing address

2100 LIBERTY RD
LEXINGTON KY
40509-4319
US

V. Phone/Fax

Practice location:
  • Phone: 502-777-2397
  • Fax: 502-808-6024
Mailing address:
  • Phone: 502-777-2397
  • Fax: 502-808-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number165432
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LEWIS
Title or Position: OWNER
Credential:
Phone: 502-777-2397