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General NPI Number Information
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NPI Number | 1366112823
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Entity Type | Organization
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Legal Business Name | CARDINAL BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 719 DISHMAN LANE EXT APT C
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4072
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Country | US
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Telephone | 270-202-8669
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Fax | 270-200-8781
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Provider Business Mailing Address
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Address Line | 719 DISHMAN LANE EXT APT C
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4072
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Country | US
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Telephone | 270-202-8669
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Fax | 270-200-8781
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOELLEN MARION
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Credential |
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Telephone | 270-202-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 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 #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #5
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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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