Healthcare Provider Details

I. General information

NPI: 1457238610
Provider Name (Legal Business Name): KENTUCKIANA TREATMENT CENTER FOR ANXIETY & OCD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 3RD ST STE 304
OWENSBORO KY
42303-4129
US

IV. Provider business mailing address

100 W 3RD ST STE 304
OWENSBORO KY
42303-4129
US

V. Phone/Fax

Practice location:
  • Phone: 270-238-3566
  • Fax:
Mailing address:
  • Phone: 270-238-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY ELIZABETH LEINS
Title or Position: OWNER
Credential: PSYD
Phone: 502-341-4742