Healthcare Provider Details

I. General information

NPI: 1457736910
Provider Name (Legal Business Name): BEAUMONT PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 LAKECREST CIR SUITE 400, PMB197
LEXINGTON KY
40513-1937
US

IV. Provider business mailing address

3070 LAKECREST CIR SUITE 400, PMB 197
LEXINGTON KY
40513-1937
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 Number
License Number State

VIII. Authorized Official

Name: DR. CLETUS SAVIO CARVALHO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 859-263-3888