Organization
OWENSBORO BEHAVIORAL CARE PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUWOLE O OLUSOLA MD (OWNER)
(812) 971-8222
Entity
Organization
Contact information
Practice address
920 FREDERICA ST STE 407, OWENSBORO, KY 42301-3079
(270) 316-9616
(812) 359-4481
Mailing address
920 FREDERICA ST STE 407, OWENSBORO, KY 42301-3079
(270) 316-9616
(812) 359-4481
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
01045882A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051385
BC/BS PIN KY
KY
05
—
64306046
—
KY
Enumeration date
10/17/2007
Last updated
02/25/2008
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