Provider Demographics
NPI:1225443005
Name:BERNARD MITCHELL PLUMLEE III
Entity Type:Organization
Organization Name:BERNARD MITCHELL PLUMLEE III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:PLUMLEE
Authorized Official - Suffix:III
Authorized Official - Credentials:CADC
Authorized Official - Phone:270-202-4688
Mailing Address - Street 1:1569 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2768
Mailing Address - Country:US
Mailing Address - Phone:270-202-4688
Mailing Address - Fax:
Practice Address - Street 1:1569 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2768
Practice Address - Country:US
Practice Address - Phone:270-202-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility