=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639721202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHJ GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2019
-----------------------------------------------------
Last Update Date | 11/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 4TH ST
-----------------------------------------------------
City | LEWISPORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42351-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-255-4341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 4TH ST
-----------------------------------------------------
City | LEWISPORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42351-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARRY JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-457-1640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------