Provider Demographics
NPI:1063017010
Name:HOLBROOK'S OPTIMAL MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:HOLBROOK'S OPTIMAL MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:606-315-3591
Mailing Address - Street 1:18312 W US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-6827
Mailing Address - Country:US
Mailing Address - Phone:606-315-3591
Mailing Address - Fax:
Practice Address - Street 1:2017 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1167
Practice Address - Country:US
Practice Address - Phone:606-315-3591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1285269340Medicaid