Provider Demographics
NPI:1083902191
Name:KVC BEHAVIORAL HEALTHCARE KENTUCKY INC
Entity Type:Organization
Organization Name:KVC BEHAVIORAL HEALTHCARE KENTUCKY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KLYACHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-322-4900
Mailing Address - Street 1:2250 THUNDERSTICK DR STE 1104
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-9009
Mailing Address - Country:US
Mailing Address - Phone:859-254-1035
Mailing Address - Fax:859-254-2075
Practice Address - Street 1:2250 THUNDERSTICK DR STE 1104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-9009
Practice Address - Country:US
Practice Address - Phone:859-254-1035
Practice Address - Fax:859-254-2075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KVC HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 103TC0700X, 1041C0700X
KY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100283480Medicaid
KY7100284110Medicaid
KY7100318330Medicaid