Healthcare Provider Details

I. General information

NPI: 1023955853
Provider Name (Legal Business Name): CUMBERLAND MOUNTAIN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MAIN ST
WILLIAMSBURG KY
40769-1123
US

IV. Provider business mailing address

323 MAIN ST
WILLIAMSBURG KY
40769-1123
US

V. Phone/Fax

Practice location:
  • Phone: 606-825-6011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAILEN WATTENBARGER BAKER
Title or Position: PMHNP/OWNER
Credential:
Phone: 606-825-6011