MEDICARE: MENTAL HEALTH CONNECTION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1205303781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH CONNECTION, INC

Provider Business Mailing Address
First Line	:	5096 MIDDLETON PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-1406
Country	:	US
Telephone Number	:	787-704-9733
Fax Number	:

Provider Business Practice Location Address
First Line	:	8501 SW 124TH AVE STE 312
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4634
Country	:	US
Telephone Number	:	713-493-2593
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK H PUGH
Credential	:	DO
Telephone Number	:	713-493-2593

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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