Provider Demographics
NPI:1134663925
Name:ADVANCED BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, APRN
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-506-2967
Mailing Address - Street 1:110 HELM STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1496
Mailing Address - Country:US
Mailing Address - Phone:270-506-2967
Mailing Address - Fax:270-900-1674
Practice Address - Street 1:110 HELM STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1496
Practice Address - Country:US
Practice Address - Phone:270-506-2967
Practice Address - Fax:270-900-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty