Provider Demographics
NPI:1750949863
Name:EASTERN KENTUCKY ABA SERVICES
Entity type:Organization
Organization Name:EASTERN KENTUCKY ABA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYBURN-DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA, MED
Authorized Official - Phone:606-465-0786
Mailing Address - Street 1:2995 BIG PERRY RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8156
Mailing Address - Country:US
Mailing Address - Phone:606-465-0786
Mailing Address - Fax:
Practice Address - Street 1:2995 BIG PERRY RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8156
Practice Address - Country:US
Practice Address - Phone:606-465-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100415390Medicaid
KY168533OtherLICENSED BEHAVIOR ANALYST