Healthcare Provider Details

I. General information

NPI: 1619612231
Provider Name (Legal Business Name): S & S BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 E PITTSBURG CHURCH RD
LONDON KY
40741-9047
US

IV. Provider business mailing address

1907 E PITTSBURG CHURCH RD
LONDON KY
40741-9047
US

V. Phone/Fax

Practice location:
  • Phone: 606-389-5269
  • Fax: 606-389-5276
Mailing address:
  • Phone: 606-389-5269
  • Fax: 606-389-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SHORT
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: PMHNP-BC
Phone: 606-389-5269