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General NPI Number Information
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NPI Number | 1538492160
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Entity Type | Organization
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Legal Business Name | KEYSTONE BEHAVIORAL HEALTH, PSC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 637 HIGHWAY 2077
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City | PINEVILLE
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State | KY
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Zip | 40977-8308
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Country | US
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Telephone | 606-337-8496
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Fax | 606-337-8496
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Provider Business Mailing Address
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Address Line | 637 HIGHWAY 2077
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City | PINEVILLE
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State | KY
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Zip | 40977-8308
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Country | US
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Telephone | 606-337-8496
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Fax | 606-337-8496
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Authorized Official
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Title or Position | OWNER
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Name | JODI LEFEVERS CARROLL
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Credential | LCSW
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Telephone | 606-337-8496
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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 | 1067
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License Number State | KY
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