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JOURNEYPURE KENTUCKY MEDICAL GROUP LLC NPI 1215470224


NPI Information

NPI: 1215470224
Provider Name: JOURNEYPURE KENTUCKY MEDICAL GROUP LLC
Classification: Psychologist - 103TA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

CLIA Number: 18D2144829

Address:
2349 RUSSELLVILLE RD
BOWLING GREEN, KY
ZIP 42101
Phone: (270) 781-3387
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JOURNEYPURE KENTUCKY MEDICAL GROUP LLC is an addiction (substance use disorder) psychologist in Bowling Green, KY. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. JOURNEYPURE KENTUCKY MEDICAL GROUP LLC NPI is 1215470224. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2349 RUSSELLVILLE RD
BOWLING GREEN, KY
ZIP 42101-986
Phone: (270) 781-3387

The provider's authorized official is Kevin D Lee .
The authorized official title is President And Ceo and has the following contact phone number (615) 973-3500.

The CLIA number assigned to this NPI record is 18D2144829 - other - aode, bhso iop with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/22/2016 and was last updated on 11/22/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TA0400XPsychologistAddiction (Substance Use Disorder)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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