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General NPI Number Information
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NPI Number | 1417250077
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Entity Type | Organization
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Legal Business Name | KENTUCKIANA BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 938 E WASHINGTON ST STE 2
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City | LOUISVILLE
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State | KY
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Zip | 40206-1634
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Country | US
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Telephone | 502-548-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 324 TUCKER STATION RD
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City | LOUISVILLE
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State | KY
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Zip | 40243-1359
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Country | US
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Telephone | 502-254-7994
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | RONALD EDWARD GOEPPER
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Credential |
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Telephone | 502-254-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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