Provider Demographics
NPI:1780448423
Name:DEMYSTIFY BEHAVIORAL AND MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DEMYSTIFY BEHAVIORAL AND MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVRON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-224-4145
Mailing Address - Street 1:3116 ALBANS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-4400
Mailing Address - Country:US
Mailing Address - Phone:502-224-4145
Mailing Address - Fax:502-963-5546
Practice Address - Street 1:4216 TELOVI CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1537
Practice Address - Country:US
Practice Address - Phone:502-224-4145
Practice Address - Fax:502-963-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health