Provider Demographics
NPI:1760039275
Name:BLUEGRASS BEHAVIORAL CONSULTING PSC
Entity Type:Organization
Organization Name:BLUEGRASS BEHAVIORAL CONSULTING PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-352-5010
Mailing Address - Street 1:2333 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3215
Practice Address - Country:US
Practice Address - Phone:859-545-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty