Provider Demographics
NPI:1215231543
Name:UNIVERSAL CONCEPTS
Entity Type:Organization
Organization Name:UNIVERSAL CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL INTERVENTIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-552-6112
Mailing Address - Street 1:241 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1521
Practice Address - Country:US
Practice Address - Phone:270-351-4859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty