Basic Information
| Provider Information | |||||||||
| NPI: | 1376161810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CLARK BEHAVIORAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1410 S CLARK BLVD # 2100 | ||||||||
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| City: | CLARKSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471293212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022449859 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 MARKET ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471118507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125035100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2020 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5022449859 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CREDENTIALING | ||||||||
| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.