Healthcare Provider Details

I. General information

NPI: 1023415692
Provider Name (Legal Business Name): STEPHENS BEHAVIOR CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
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: 502-633-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1519
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberKY-0060
License Number StateKY

VIII. Authorized Official

Name: MR. KYLE STEPHENS
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA, LBA
Phone: 502-633-1315