Basic Information
| Provider Information | |||||||||
| NPI: | 1104237049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KVC BEHAVIORAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 BEASLEY ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405094266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
| FaxNumber: | 8592542075 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 BEASLEY ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405094266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
| FaxNumber: | 8592542075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | GARRETT | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FPP SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3178403434 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.