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General NPI Number Information
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NPI Number | 1235774522
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Entity Type | Organization
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Legal Business Name | HARBOR OF HOPE MEDICAL AND BEHAVIORAL HEALTH CARE, LLC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 185 TREUHAFT BLVD APT 4
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City | BARBOURVILLE
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State | KY
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Zip | 40906-8300
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Country | US
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Telephone | 606-545-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 868 SAM PARKER RD
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City | GRAY
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State | KY
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Zip | 40734-6780
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Country | US
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Telephone | 606-269-3428
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. THELMA J GRAY
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Credential | APRN
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Telephone | 606-269-3428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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