Healthcare Provider Details

I. General information

NPI: 1053578443
Provider Name (Legal Business Name): SAINT JOSEPH BEHAVIORAL MEDICINE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORPORATE DR SUITE 103
LEXINGTON KY
40503-5432
US

IV. Provider business mailing address

861 CORPORATE DR SUITE 103
LEXINGTON KY
40503-5432
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-2022
  • Fax: 859-224-2024
Mailing address:
  • Phone: 859-224-2022
  • Fax: 859-224-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BROWN
Title or Position: DIRECTOR OF NETWORK OPERATIONS
Credential:
Phone: 859-977-8064