Provider Demographics
NPI:1952840860
Name:BLUEGRASS BEHAVIORAL HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:BLUEGRASS BEHAVIORAL HEALTH GROUP, LLC
Other - Org Name:CULTIVATE BEHAVIORAL HEALTH AND EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:CURLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-955-1099
Mailing Address - Street 1:12600 HILL COUNTRY BLVD STE R-100
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6748
Mailing Address - Country:US
Mailing Address - Phone:512-772-4042
Mailing Address - Fax:512-842-7446
Practice Address - Street 1:925 DUDLEY PIKE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-8120
Practice Address - Country:US
Practice Address - Phone:859-360-3006
Practice Address - Fax:859-360-3053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULTIVATE BEHAVIORAL MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100446170Medicaid