Healthcare Provider Details

I. General information

NPI: 1750949863
Provider Name (Legal Business Name): EASTERN KENTUCKY ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 BIG PERRY RD
MOREHEAD KY
40351-8156
US

IV. Provider business mailing address

2995 BIG PERRY RD
MOREHEAD KY
40351-8156
US

V. Phone/Fax

Practice location:
  • Phone: 606-465-0786
  • Fax:
Mailing address:
  • Phone: 606-465-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LORI RAYBURN-DEHART
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA, LBA, M.ED
Phone: 606-465-0786