Full Name | |
---|---|
Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 102 Bond St, Berea, Kentucky |
Authorized Official Name and Position | Heather Wilson (CREDENTIALING MANAGER) |
Authorized Official Contact | 9038188312 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
102 Bond St Berea KY 40403-1502 Ph: () - | 102 Bond St Berea KY 40403-1502 Ph: (859) 353-7562 |
NPI Number | 1992440259 |
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Provider Enumeration Date | 05/02/2022 |
Last Update Date | 03/11/2023 |
Certification Date | 03/11/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992440259 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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