Provider Demographics
NPI:1366112823
Name:CARDINAL BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:CARDINAL BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-202-8669
Mailing Address - Street 1:719 DISHMAN LANE EXT APT C
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4072
Mailing Address - Country:US
Mailing Address - Phone:270-202-8669
Mailing Address - Fax:270-200-8781
Practice Address - Street 1:719 DISHMAN LANE EXT APT C
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4072
Practice Address - Country:US
Practice Address - Phone:270-202-8669
Practice Address - Fax:270-200-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100886940Medicaid