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General NPI Number Information
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NPI Number | 1518235183
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Entity Type | Organization
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Legal Business Name | DBT CENTER OF WESTERN KENTUCKY, LLC
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 1300 ANDREA ST SUITE 205
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-904-2260
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Fax | 270-781-9680
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Provider Business Mailing Address
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Address Line | 1300 ANDREA ST SUITE 205
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-904-2260
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Fax | 270-781-9680
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA M SMITH
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Credential | LMSW BCD
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Telephone | 270-904-2260
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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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Taxonomy #2
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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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