Basic Information
| Provider Information | |||||||||
| NPI: | 1528498318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KVC BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 BEASLEY ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405094266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 BEASLEY ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405094266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2013 | ||||||||
| LastUpdateDate: | 11/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | MATTINGLY | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | MEDLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | FPP SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5023217618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 1041C0700X | KY | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.