Provider Demographics
NPI:1689095531
Name:WESTERN KENTUCKY REGIONAL MENTAL HEALTH AND MENTAL RETARDATION ADVISOR
Entity Type:Organization
Organization Name:WESTERN KENTUCKY REGIONAL MENTAL HEALTH AND MENTAL RETARDATION ADVISOR
Other - Org Name:FOUR RIVERS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:270-442-7121
Mailing Address - Street 1:425 BROADWAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-0713
Mailing Address - Country:US
Mailing Address - Phone:270-442-7121
Mailing Address - Fax:270-443-9692
Practice Address - Street 1:425 BROADWAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0713
Practice Address - Country:US
Practice Address - Phone:270-442-7121
Practice Address - Fax:270-443-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800001343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)