Provider Demographics
NPI:1760934350
Name:KEYSTONE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:KEYSTONE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA, NCC
Authorized Official - Phone:828-331-3010
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28725-0232
Mailing Address - Country:US
Mailing Address - Phone:828-331-3010
Mailing Address - Fax:
Practice Address - Street 1:582 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5543
Practice Address - Country:US
Practice Address - Phone:828-331-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health