| Mindlift Llc | |
|
519 Licking Pike Wilder KY 41071-2941 | |
| (859) 572-0400 | |
| (859) 442-3363 |
| Full Name | Mindlift Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 519 Licking Pike, Wilder, Kentucky |
| Authorized Official Name and Position | Troy Duane Witte (GM) |
| Authorized Official Contact | 8596556026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindlift Llc 519 Licking Pike Wilder KY 41071-2941 Ph: (859) 572-0400 | Mindlift Llc 519 Licking Pike Wilder KY 41071-2941 Ph: (859) 572-0400 |
| NPI Number | 1013676345 |
|---|---|
| Provider Enumeration Date | 12/14/2021 |
| Last Update Date | 10/12/2023 |
| Certification Date | 10/12/2023 |
| Medicare PECOS PAC ID | 1355795840 |
|---|---|
| Medicare Enrollment ID | O20231003001149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013676345 | NPI | - | NPPES |
| 7100926170 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kimberly Michelle Witte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437290822 PECOS PAC ID: 4082068572 Enrollment ID: I20231207002290 |
| Provider Name | Jennifer Lynn Hawkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194426742 PECOS PAC ID: 6204286859 Enrollment ID: I20231222002448 |
| Provider Name | Lonna Larger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629555321 PECOS PAC ID: 9931445905 Enrollment ID: I20240306004129 |
Kathryn Blair Plymale Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 519 Licking Pike, Wilder, KY 41071 Phone: 606-669-1031 | |
Therapeutic Collaborative Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 519 Licking Pike, Wilder, KY 41071 Phone: 859-572-0400 Fax: 859-442-3363 | |
Lifes Journey Therapy And Counseling Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 519 Licking Pike, Wilder, KY 41071 Phone: 859-441-2100 Fax: 859-441-2111 | |
Therapeutic Collabortive Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 525 Licking Pike, Wilder, KY 41071 Phone: 859-572-0400 Fax: 859-442-3363 |