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General NPI Number Information
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NPI Number | 1063394567
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Entity Type | Organization
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Legal Business Name | SAGEBROOK BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 160 MOORE DR STE 205
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City | LEXINGTON
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State | KY
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Zip | 40503-2951
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Country | US
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Telephone | 859-457-1904
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Fax | 859-214-7634
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Provider Business Mailing Address
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Address Line | 160 MOORE DR STE 205
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City | LEXINGTON
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State | KY
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Zip | 40503-2951
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Country | US
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Telephone | 859-489-4126
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Fax | 859-214-7634
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAY I MIREMBO
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Credential | MD
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Telephone | 859-489-4126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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