Healthcare Provider Details

I. General information

NPI: 1972357234
Provider Name (Legal Business Name): AEGIS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 W HIGHWAY 80
SOMERSET KY
42503-1713
US

IV. Provider business mailing address

671 W HIGHWAY 80
SOMERSET KY
42503-1713
US

V. Phone/Fax

Practice location:
  • Phone: 606-425-4567
  • Fax:
Mailing address:
  • Phone: 606-425-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMMY COX
Title or Position: CO-OWNER
Credential:
Phone: 606-425-4567