Healthcare Provider Details

I. General information

NPI: 1467485110
Provider Name (Legal Business Name): MERIT BEHAVIORAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 NORTH 7TH STREET
MAYFIELD KY
42066
US

IV. Provider business mailing address

224 NORTH 7TH STREET BOX 484
MAYFIELD KY
42066-2223
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-3666
  • Fax: 270-251-3506
Mailing address:
  • Phone: 270-251-3666
  • Fax: 270-251-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MINA SMITH
Title or Position: ADMININSTRATOR
Credential: LCSW
Phone: 270-251-3666