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General NPI Number Information
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NPI Number | 1649090804
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Entity Type | Organization
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Legal Business Name | ALLY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 1616 N MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1251
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Country | US
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Telephone | 888-920-9004
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 STAR SHOOT PKWY STE 170-101
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City | LEXINGTON
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State | KY
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Zip | 40509-4566
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Country | US
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Telephone | 888-920-9004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAWN SMITH
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Credential |
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Telephone | 775-300-0282
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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