Healthcare Provider Details

I. General information

NPI: 1952994055
Provider Name (Legal Business Name): UNBOUND TREATMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N SHORE DR STE 102
JEFFERSONVILLE IN
47130-3144
US

IV. Provider business mailing address

PO BOX 623
JAMESTOWN KY
42629-0623
US

V. Phone/Fax

Practice location:
  • Phone: 866-286-2686
  • Fax: 855-929-4545
Mailing address:
  • Phone: 866-286-2686
  • Fax: 855-929-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA WHITES
Title or Position: LAWYER
Credential:
Phone: 502-352-2373