Provider Demographics
NPI:1538492160
Name:KEYSTONE BEHAVIORAL HEALTH, PSC
Entity Type:Organization
Organization Name:KEYSTONE BEHAVIORAL HEALTH, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LEFEVERS
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-337-8496
Mailing Address - Street 1:637 HIGHWAY 2077
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-8308
Mailing Address - Country:US
Mailing Address - Phone:606-337-8496
Mailing Address - Fax:606-337-8496
Practice Address - Street 1:637 HIGHWAY 2077
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8308
Practice Address - Country:US
Practice Address - Phone:606-337-8496
Practice Address - Fax:606-337-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty