Provider Demographics
NPI:1013197078
Name:FAMILY DYNAMICS BEHAVIORAL HEALTH CARE PLLC
Entity Type:Organization
Organization Name:FAMILY DYNAMICS BEHAVIORAL HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-351-4880
Mailing Address - Street 1:299 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-3305
Mailing Address - Country:US
Mailing Address - Phone:270-351-4880
Mailing Address - Fax:270-351-4881
Practice Address - Street 1:299 W LINCOLN TRAIL BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-3305
Practice Address - Country:US
Practice Address - Phone:270-351-4880
Practice Address - Fax:270-351-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1041C0700X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82001355Medicaid