Provider Demographics
NPI:1194156596
Name:WESTERN KENTUCKY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:WESTERN KENTUCKY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-213-3635
Mailing Address - Street 1:2363 LYCE DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:KY
Mailing Address - Zip Code:42409-9761
Mailing Address - Country:US
Mailing Address - Phone:270-213-0094
Mailing Address - Fax:270-693-9499
Practice Address - Street 1:2363 LYCE DUNCAN RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409-9761
Practice Address - Country:US
Practice Address - Phone:270-213-3635
Practice Address - Fax:270-213-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty