Provider Demographics
NPI:1831433655
Name:FAMILY & CHILDREN BEHAVIOR HEALTH SERVICE PSC
Entity type:Organization
Organization Name:FAMILY & CHILDREN BEHAVIOR HEALTH SERVICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARANISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-561-1112
Mailing Address - Street 1:302 E BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2328
Mailing Address - Country:US
Mailing Address - Phone:502-561-1112
Mailing Address - Fax:502-561-1113
Practice Address - Street 1:302 E BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2328
Practice Address - Country:US
Practice Address - Phone:502-561-1112
Practice Address - Fax:502-561-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty