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General NPI Number Information
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NPI Number | 1619891421
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Entity Type | Organization
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Legal Business Name | TELOS HEALTH SYSTEMS KY PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 3500 GOOD SAMARITAN WAY
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City | LOUISVILLE
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State | KY
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Zip | 40299-6117
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Country | US
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Telephone | 201-217-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 980 SYLVAN AVE FL 2
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-3320
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Country | US
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Telephone | 201-217-6777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PETER BAILEY
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Credential |
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Telephone | 201-217-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 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 #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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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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