Basic Information
| Provider Information | |||||||||
| NPI: | 1154638088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 SANTA CLARA VALLEY LN APT 8 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 SANTA CLARA VALLEY LN APT 8 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 09/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | KINNE | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | STAFF THERAPIST/CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8125377382 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | M.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | S.1000210 | OH | Y | Agencies | Case Management |
No ID Information.