Provider Demographics
NPI:1922499201
Name:BLUEGRASS BEHAVIOR SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BLUEGRASS BEHAVIOR SOLUTIONS, LLC
Other - Org Name:BLUEGRASS COMMUNITY SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:859-516-2360
Mailing Address - Street 1:PO BOX 1673
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-1673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 PROSPEROUS PL
Practice Address - Street 2:SUITE 1B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2180
Practice Address - Country:US
Practice Address - Phone:859-516-2360
Practice Address - Fax:859-587-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0002103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty