Healthcare Provider Details

I. General information

NPI: 1245662386
Provider Name (Legal Business Name): STEPHENS BEHAVIOR CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MAIN ST
SHELBYVILLE KY
40065-1026
US

IV. Provider business mailing address

PO BOX 516
SHELBYVILLE KY
40066-0516
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1315
  • Fax: 502-633-1316
Mailing address:
  • Phone: 502-633-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberKY-0060
License Number StateKY

VIII. Authorized Official

Name: MR. KYLE A. STEPHENS
Title or Position: LICENSED BEHAVIOR ANALYST
Credential: BCBA, LBA
Phone: 502-794-6074