Provider Demographics
NPI:1063394567
Name:SAGEBROOK BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:SAGEBROOK BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MIREMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-457-1904
Mailing Address - Street 1:3360 BLACKFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9070
Mailing Address - Country:US
Mailing Address - Phone:859-457-1904
Mailing Address - Fax:
Practice Address - Street 1:160 MOORE DR STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2951
Practice Address - Country:US
Practice Address - Phone:859-457-1904
Practice Address - Fax:859-214-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty