Healthcare Provider Details

I. General information

NPI: 1811836752
Provider Name (Legal Business Name): PROSPERA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 HOUSTON RD STE 24
FLORENCE KY
41042-4890
US

IV. Provider business mailing address

6900 HOUSTON RD STE 24
FLORENCE KY
41042-4890
US

V. Phone/Fax

Practice location:
  • Phone: 859-250-9148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANALISA HAGSTROM
Title or Position: CO-OWNER
Credential: LPCC
Phone: 859-250-9148