MEDICARE: BETTER MENTAL HEALTH KY, LLC

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	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1376217638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTER MENTAL HEALTH KY, LLC

Provider Business Mailing Address
First Line	:	1229 COLORADO RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2397
Country	:	US
Telephone Number	:	859-888-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 COLORADO RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2397
Country	:	US
Telephone Number	:	859-888-0262
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	SARAH MALIK
Credential	:
Telephone Number	:	859-888-0262

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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