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General NPI Number Information
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NPI Number | 1457012486
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Entity Type | Organization
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Legal Business Name | CUMBERLAND MOUNTAIN BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 323 MAIN ST
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-1123
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Country | US
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Telephone | 606-825-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 67 CANYON DR
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City | LONDON
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State | KY
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Zip | 40741-7829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAILEN BAKER
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Credential | DNP
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Telephone | 606-401-3185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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