Healthcare Provider Details

I. General information

NPI: 1477692242
Provider Name (Legal Business Name): KINGSPOINTE BEHAVIORAL HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MARION ST SUITE 207
SHELBY NC
28150-5091
US

IV. Provider business mailing address

201 W MARION ST SUITE 207
SHELBY NC
28150-5091
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-6226
  • Fax: 704-487-6286
Mailing address:
  • Phone: 704-487-6226
  • Fax: 704-487-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-023-046
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-023-128
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-055-090
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-055-091
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2260
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5595
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LLRAE SCOTT
Title or Position: EXECUTIVEDIRECTORCLINICALSERVICES
Credential: B.S., QMHP
Phone: 704-487-6226