Provider Demographics
NPI:1780109827
Name:COMMONWEALTH BEHAVIORAL HEALTH & COUNSELING
Entity type:Organization
Organization Name:COMMONWEALTH BEHAVIORAL HEALTH & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-520-3041
Mailing Address - Street 1:29 N MAYSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1471
Mailing Address - Country:US
Mailing Address - Phone:859-520-3041
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:10 COURT ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1303
Practice Address - Country:US
Practice Address - Phone:859-520-3041
Practice Address - Fax:859-432-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100503630Medicaid