| Primary Purpose Behavioral Health | |
|
715 Shaker Dr Ste 80 Lexington KY 40504-3628 | |
| (859) 810-5150 | |
| (859) 972-0850 |
| Full Name | Primary Purpose Behavioral Health |
|---|---|
| Speciality | Counselor |
| Location | 715 Shaker Dr Ste 80, Lexington, Kentucky |
| Authorized Official Name and Position | David Waters (PARTNER) |
| Authorized Official Contact | 5023701803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Purpose Behavioral Health 449 Cunningham Ln Lexington KY 40508-2156 Ph: () - | Primary Purpose Behavioral Health 715 Shaker Dr Ste 80 Lexington KY 40504-3628 Ph: (859) 810-5150 |
| NPI Number | 1417608738 |
|---|---|
| Provider Enumeration Date | 01/18/2022 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 3971951351 |
|---|---|
| Medicare Enrollment ID | O20231122003236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417608738 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | David Waters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427400977 PECOS PAC ID: 5193158855 Enrollment ID: I20191210003330 |
| Provider Name | Jessica Duval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295236537 PECOS PAC ID: 3870909245 Enrollment ID: I20210309002995 |
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