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General NPI Number Information
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NPI Number | 1922499201
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Entity Type | Organization
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Legal Business Name | BLUEGRASS BEHAVIOR SOLUTIONS, LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 151 PROSPEROUS PL SUITE 1B
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City | LEXINGTON
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State | KY
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Zip | 40509-2180
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Country | US
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Telephone | 859-516-2360
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Fax | 859-587-9710
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Provider Business Mailing Address
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Address Line | PO BOX 1673
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City | DANVILLE
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State | KY
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Zip | 40423-1673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EDWARD D PARKER
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Credential | PHD, BCBA-D
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Telephone | 859-516-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | KY-0002
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License Number State | KY
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