Healthcare Provider Details

I. General information

NPI: 1487570057
Provider Name (Legal Business Name): NORTHERN KENTUCKY BEHAVIORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DOLWICK DR
ERLANGER KY
41018-2774
US

IV. Provider business mailing address

820 DOLWICK DR
ERLANGER KY
41018-2774
US

V. Phone/Fax

Practice location:
  • Phone: 859-429-5188
  • Fax: 859-578-2875
Mailing address:
  • Phone: 859-429-5188
  • Fax: 859-578-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEANNA MCCLENDON
Title or Position: DIRECTOR OF PROVIDER CREDENTIALING
Credential:
Phone: 678-698-2070