MEDICARE: NATIONAL BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	47019	KY

General Provider Information

NPI Number	:	1093108474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 910650
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40591-0650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 EVERETTS DL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1190
Country	:	US
Telephone Number	:	859-737-0904
Fax Number	:	859-737-0902

Authorized Official
Title or Position	:	OWNER
Name	:	OSAMA ALI
Credential	:	M.D.
Telephone Number	:	859-737-0904

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	08/17/2015

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Directions to “NATIONAL BEHAVIORAL HEALTH ” Practice Location

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