Healthcare Provider Details

I. General information

NPI: 1336723642
Provider Name (Legal Business Name): BEHAVIORAL HEALTH OUTPATIENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FARRA DR
LANCASTER KY
40444-8764
US

IV. Provider business mailing address

185 FARRA DR
LANCASTER KY
40444-8764
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax: 859-813-5394
Mailing address:
  • Phone: 606-638-0938
  • Fax: 859-813-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMMY ROBINSON
Title or Position: CEO
Credential:
Phone: 606-638-0938