Basic Information
| Provider Information | |||||||||
| NPI: | 1053578443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT JOSEPH BEHAVIORAL MEDICINE NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BEHAVIORAL MEDICINE NETWORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 CORPORATE DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405035432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592242022 | ||||||||
| FaxNumber: | 8592242024 | ||||||||
| Practice Location | |||||||||
| Address1: | 861 CORPORATE DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405035432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592242022 | ||||||||
| FaxNumber: | 8592242024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF NETWORK OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8599778064 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC1900X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.