Healthcare Provider Details

I. General information

NPI: 1689573735
Provider Name (Legal Business Name): BLUEGRASS WELLNESS & MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 HIGHTOP RD
CORBIN KY
40701-7502
US

IV. Provider business mailing address

3125 HIGHTOP RD
CORBIN KY
40701-7502
US

V. Phone/Fax

Practice location:
  • Phone: 606-521-9324
  • Fax:
Mailing address:
  • Phone: 606-521-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL K BRAY
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 606-521-9324