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General NPI Number Information
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NPI Number | 1134663925
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH, PLLC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 110 HELM STREET
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1496
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Country | US
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Telephone | 270-506-2967
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Fax | 270-900-1674
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Provider Business Mailing Address
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Address Line | 110 HELM STREET
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1496
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Country | US
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Telephone | 270-506-2967
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Fax | 270-900-1674
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Authorized Official
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Title or Position | RN, APRN
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Name | DEBRA JOHNSON
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Credential |
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Telephone | 270-506-2967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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