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General NPI Number Information
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NPI Number | 1326663766
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Entity Type | Organization
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Legal Business Name | SAKURA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 125 QUINN DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1370
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Country | US
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Telephone | 859-241-3085
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Fax | 877-712-3835
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Provider Business Mailing Address
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Address Line | 125 QUINN DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1370
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Country | US
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Telephone | 859-241-3085
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Fax | 877-712-3835
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Authorized Official
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Title or Position | CO-OWNER/CLINICAL COUNSELOR
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Name | MRS. JESSICA LYNN SPEELMAN
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Credential | M.ED, LPCC
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Telephone | 859-354-9360
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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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