Provider Demographics
NPI:1841049855
Name:ADVANCED BEHAVIORAL WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ADKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-898-4044
Mailing Address - Street 1:5050 VILLAGE SQUARE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7552
Mailing Address - Country:US
Mailing Address - Phone:270-898-4044
Mailing Address - Fax:270-898-4045
Practice Address - Street 1:5050 VILLAGE SQUARE DR STE B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7552
Practice Address - Country:US
Practice Address - Phone:270-898-4044
Practice Address - Fax:270-898-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty