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General NPI Number Information
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NPI Number | 1457063067
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Entity Type | Organization
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Legal Business Name | KH BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 200 N ALABAMA ST
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City | CROSSETT
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State | AR
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Zip | 71635-2808
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Country | US
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Telephone | 318-789-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 212 ASHLEY ROAD 203
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City | CROSSETT
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State | AR
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Zip | 71635-9060
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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 | KAYLEY HARRIS
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Credential | LCSW
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Telephone | 318-789-4399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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