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General NPI Number Information
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NPI Number | 1679042279
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR MENTAL HEALTH
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 33 JACKS LN
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City | SOMERSET
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State | KY
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Zip | 42501-6152
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Country | US
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Telephone | 606-679-0014
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Fax | 606-679-0024
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Provider Business Mailing Address
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Address Line | 33 JACKS LN
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City | SOMERSET
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State | KY
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Zip | 42501-6152
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Country | US
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Telephone | 606-679-0014
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Fax | 606-679-0024
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE L TILLERY
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Credential | LCSW
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Telephone | 859-868-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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