Provider Demographics
NPI:1265542203
Name:NORTHERN KENTUCKY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NORTHERN KENTUCKY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:859-282-1202
Mailing Address - Street 1:7000 HOUSTON RD STE 15
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4882
Mailing Address - Country:US
Mailing Address - Phone:859-282-1202
Mailing Address - Fax:859-746-1496
Practice Address - Street 1:7000 HOUSTON RD STE 15
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-282-1208
Practice Address - Fax:513-297-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104006101YP2500X
KYKY-0119101Y00000X, 101YA0400X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100286970Medicaid