| Spectra Mental Healthcare, Pllc | |
|
214 Breckenridge Ln 104 Louisville KY 40207-3868 | |
| (502) 893-3388 | |
| Not Available |
| Full Name | Spectra Mental Healthcare, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 214 Breckenridge Ln, Louisville, Kentucky |
| Authorized Official Name and Position | Karl Bates (OWNER) |
| Authorized Official Contact | 5028933388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectra Mental Healthcare, Pllc 214 Breckenridge Ln 104 Louisville KY 40207-3868 Ph: () - | Spectra Mental Healthcare, Pllc 214 Breckenridge Ln 104 Louisville KY 40207-3868 Ph: (502) 893-3388 |
| NPI Number | 1275684698 |
|---|---|
| Provider Enumeration Date | 01/13/2007 |
| Last Update Date | 05/19/2008 |
| Medicare PECOS PAC ID | 6507835022 |
|---|---|
| Medicare Enrollment ID | O20040930000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275684698 | NPI | - | NPPES |
| 000000344330 | Other | KY | ANTHEM BLUE CROSS & BLUE SHIELD |
| 8290021800 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Karl Robert Bates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720139140 PECOS PAC ID: 5092784512 Enrollment ID: I20041004000878 |
| Provider Name | Mina R Thevenin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467473488 PECOS PAC ID: 8022087055 Enrollment ID: I20041007000012 |
| Provider Name | Wayne Herner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861679375 PECOS PAC ID: 0244488534 Enrollment ID: I20120911000514 |
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