Healthcare Provider Details

I. General information

NPI: 1831969500
Provider Name (Legal Business Name): CRESCENT PSYCHIATRIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 ALVEY PARK DR W STE 200
OWENSBORO KY
42303-2105
US

IV. Provider business mailing address

3032 ALVEY PARK DR W STE 200
OWENSBORO KY
42303-2105
US

V. Phone/Fax

Practice location:
  • Phone: 270-302-6520
  • Fax:
Mailing address:
  • Phone: 270-302-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENCE BRROKS
Title or Position: OWNER
Credential: APRN
Phone: 270-925-4368