Provider Demographics
NPI:1669165288
Name:MINDWELL MENTAL HEALTHCARE OF KENTUCKY LLC
Entity type:Organization
Organization Name:MINDWELL MENTAL HEALTHCARE OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/EMPLOYEE/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FECK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-295-6431
Mailing Address - Street 1:1025 MONARCH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1931
Mailing Address - Country:US
Mailing Address - Phone:859-295-6431
Mailing Address - Fax:859-208-1325
Practice Address - Street 1:1025 MONARCH ST STE 180
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1931
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty