Provider Demographics
NPI:1629761457
Name:RED RIVER BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RED RIVER BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-481-8017
Mailing Address - Street 1:142 SPENCER LN
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-9722
Mailing Address - Country:US
Mailing Address - Phone:606-481-8017
Mailing Address - Fax:
Practice Address - Street 1:142 SPENCER LN
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312-9722
Practice Address - Country:US
Practice Address - Phone:606-481-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty