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General NPI Number Information
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NPI Number | 1447619598
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND REG MHMR BOARD CDO
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 130 SOUTHERN SCHOOL RD
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City | SOMERSET
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State | KY
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Zip | 42501-3223
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Country | US
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Telephone | 606-679-4782
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Fax |
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Provider Business Mailing Address
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Address Line | 130 SOUTHERN SCHOOL RD
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City | SOMERSET
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State | KY
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Zip | 42501-3223
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Country | US
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Telephone | 606-679-4782
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Fax |
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Authorized Official
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Title or Position | ASSISTANT TO THE CEO
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Name | TRACIE HORTON
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Credential |
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Telephone | 606-679-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 800019
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License Number State | KY
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