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General NPI Number Information
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NPI Number | 1790057313
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 3175 CUSTER DR SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40517-4023
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Country | US
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Telephone | 859-273-1288
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Fax | 859-273-1278
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Provider Business Mailing Address
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Address Line | 3175 CUSTER DR SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40517-4023
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Country | US
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Telephone | 859-273-1288
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Fax | 859-273-1278
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DANA L. LANDRY
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Credential | APRN
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Telephone | 859-273-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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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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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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