Healthcare Provider Details

I. General information

NPI: 1093108474
Provider Name (Legal Business Name): NATIONAL BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 EVERETTS DL
LEXINGTON KY
40514-1190
US

IV. Provider business mailing address

PO BOX 910650
LEXINGTON KY
40591-0650
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47019
License Number StateKY

VIII. Authorized Official

Name: OSAMA ALI
Title or Position: OWNER
Credential: M.D.
Phone: 859-737-0904