Provider Demographics
NPI:1831712603
Name:FOUR LEAF BEHAVIORAL HEALTH & CONSULTING INC.
Entity type:Organization
Organization Name:FOUR LEAF BEHAVIORAL HEALTH & CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT-LOUGHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-532-0985
Mailing Address - Street 1:12239 HAMPTON VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2039
Mailing Address - Country:US
Mailing Address - Phone:315-532-0985
Mailing Address - Fax:
Practice Address - Street 1:12239 HAMPTON VALLEY TER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2039
Practice Address - Country:US
Practice Address - Phone:315-532-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty