Organization
KVC BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA MEDLEY MATTINGLY BS (FPP SUPERVISOR)
(502) 321-7618
Entity
Organization
Contact information
Practice address
900 BEASLEY ST, LEXINGTON, KY 40509-4266
(859) 254-1035
Mailing address
900 BEASLEY ST, LEXINGTON, KY 40509-4266
(859) 254-1035
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1041C0700X
KY
Other
Enumeration date
11/15/2013
Last updated
11/15/2013
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