Provider Demographics
NPI:1790372969
Name:BINGHAM BEHAVIORAL HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:BINGHAM BEHAVIORAL HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:859-545-9752
Mailing Address - Street 1:417 KNOX ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1342
Mailing Address - Country:US
Mailing Address - Phone:606-545-9752
Mailing Address - Fax:
Practice Address - Street 1:417 KNOX ST STE 3
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1342
Practice Address - Country:US
Practice Address - Phone:606-545-9752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY810285OtherOFFICE OF INSPECTOR GENERAL
KYPENDINGMedicaid