Healthcare Provider Details

I. General information

NPI: 1124690151
Provider Name (Legal Business Name): RAD BEHAVIOR SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 CHERRY ST
SHEPHERDSVILLE KY
40165-5909
US

IV. Provider business mailing address

297 CHERRY ST
SHEPHERDSVILLE KY
40165-5909
US

V. Phone/Fax

Practice location:
  • Phone: 502-807-5333
  • Fax:
Mailing address:
  • Phone: 502-807-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R LAYMAN
Title or Position: CLINICAL DIRECTOR
Credential: BCBA
Phone: 502-807-5333