Provider Demographics
NPI:1013383884
Name:DELTA BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DELTA BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:KENTUCKY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-713-2555
Mailing Address - Street 1:9016 TAYLORSVILLE RD
Mailing Address - Street 2:#198
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1750
Mailing Address - Country:US
Mailing Address - Phone:502-713-2555
Mailing Address - Fax:888-343-1870
Practice Address - Street 1:2210 GOLDSMITH LN
Practice Address - Street 2:SUITE 204 C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-713-2555
Practice Address - Fax:888-343-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLCSW 30091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty