Provider Demographics
NPI:1902565054
Name:BAIRD, BRIANNA JANE (BS, TCADC)
Entity Type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:JANE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:BS, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STONEY FORK RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8875
Mailing Address - Country:US
Mailing Address - Phone:419-231-7123
Mailing Address - Fax:
Practice Address - Street 1:3110 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8681
Practice Address - Country:US
Practice Address - Phone:606-523-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY171M00000XMedicaid