Healthcare Provider Details

I. General information

NPI: 1619616679
Provider Name (Legal Business Name): HALCYON BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 CUSTER DR STE 103
LEXINGTON KY
40517-4018
US

IV. Provider business mailing address

3167 CUSTER DR STE 103
LEXINGTON KY
40517-4018
US

V. Phone/Fax

Practice location:
  • Phone: 859-286-9182
  • Fax: 859-399-6877
Mailing address:
  • Phone: 859-286-9182
  • Fax: 859-399-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ELIZABETH DUVAL
Title or Position: OWNER
Credential: LCSW
Phone: 859-286-9182