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General NPI Number Information
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NPI Number | 1992412506
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Entity Type | Organization
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Legal Business Name | BLUEGRASS BRAIN HEALTH LLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1056 WELLINGTON WAY STE 160
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City | LEXINGTON
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State | KY
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Zip | 40513-2002
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Country | US
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Telephone | 859-800-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MILL SPRINGS CIR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8751
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Country | US
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Telephone | 805-540-0172
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY BASSEL
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Credential |
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Telephone | 859-475-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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