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General NPI Number Information
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NPI Number | 1851059083
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Entity Type | Organization
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Legal Business Name | RIGHT TRACK BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 710 E MAIN ST
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City | LEXINGTON
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State | KY
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Zip | 40502-1668
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Country | US
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Telephone | 859-517-5461
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 ICE HOUSE WAY
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City | LEXINGTON
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State | KY
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Zip | 40509-8638
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Country | US
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Telephone | 859-421-4086
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIRANDA HAGAN
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Credential |
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Telephone | 859-421-4086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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