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General NPI Number Information
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NPI Number | 1578234449
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Entity Type | Organization
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Legal Business Name | BLUEGRASS BEHAVIORAL HEALTH & CONSULTING SERVICES
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 08/13/2022
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Provider Practice Location Address
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Address Line | 601 DOE RUN DR STE 5
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City | MT STERLING
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State | KY
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Zip | 40353-9097
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Country | US
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Telephone | 859-432-3055
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Fax | 859-432-3044
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Provider Business Mailing Address
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Address Line | 601 DOE RUN DR STE 5
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City | MT STERLING
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State | KY
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Zip | 40353-9097
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Country | US
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Telephone | 859-432-3055
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Fax | 859-432-3044
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Authorized Official
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Title or Position | CEO
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Name | SHAWNDA CARTER
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Credential | APRN, PMHNP-BC
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Telephone | 859-274-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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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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