Provider Demographics
NPI:1619088549
Name:LOUISVILLE BEHAVIORAL HEALTH SYSTEMS PLLC
Entity Type:Organization
Organization Name:LOUISVILLE BEHAVIORAL HEALTH SYSTEMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ZWANZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-454-8800
Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2497
Mailing Address - Country:US
Mailing Address - Phone:502-454-8800
Mailing Address - Fax:502-736-0140
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2497
Practice Address - Country:US
Practice Address - Phone:502-454-8800
Practice Address - Fax:502-736-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100152610Medicaid
KY7100041560Medicaid
KY7100152610Medicaid