Provider Demographics
NPI:1467123752
Name:BROADLEAF BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:BROADLEAF BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:859-391-1344
Mailing Address - Street 1:840 BAGBY RD
Mailing Address - Street 2:
Mailing Address - City:CRITTENDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41030-8957
Mailing Address - Country:US
Mailing Address - Phone:859-391-1344
Mailing Address - Fax:
Practice Address - Street 1:840 BAGBY RD
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8957
Practice Address - Country:US
Practice Address - Phone:859-391-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health