Provider Demographics
NPI:1457736910
Name:BEAUMONT PSYCHIATRY PLLC
Entity type:Organization
Organization Name:BEAUMONT PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CLETUS
Authorized Official - Middle Name:SAVIO
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-263-3888
Mailing Address - Street 1:3070 LAKECREST CIR
Mailing Address - Street 2:SUITE 400, PMB 197
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3070 LAKECREST CIR
Practice Address - Street 2:SUITE 400, PMB197
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1937
Practice Address - Country:US
Practice Address - Phone:859-737-0904
Practice Address - Fax:859-737-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64059330Medicaid