Healthcare Provider Details

I. General information

NPI: 1447115274
Provider Name (Legal Business Name): MIND BODY & SOUL BEHAVIORAL HEALTH & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 WESTPORT RD STE D
ELIZABETHTOWN KY
42701-2950
US

IV. Provider business mailing address

551 WESTPORT RD STE D
ELIZABETHTOWN KY
42701-2950
US

V. Phone/Fax

Practice location:
  • Phone: 502-249-9617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DARLENA SMITH
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 502-249-9617