Healthcare Provider Details

I. General information

NPI: 1679681605
Provider Name (Legal Business Name): UNIVERSAL BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL HEIGHTS DR
FRANKFORT KY
40601-4137
US

IV. Provider business mailing address

PO BOX 896
WINCHESTER KY
40392-0896
US

V. Phone/Fax

Practice location:
  • Phone: 502-696-9543
  • Fax:
Mailing address:
  • Phone: 859-737-0904
  • Fax: 859-737-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID L. CARTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 859-737-0904