Healthcare Provider Details

I. General information

NPI: 1295553816
Provider Name (Legal Business Name): NOURISH MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W HIGHWAY 146 STE 200
PEWEE VALLEY KY
40056-8110
US

IV. Provider business mailing address

3014 FAIRWAY DR
FLOYDS KNOBS IN
47119-9615
US

V. Phone/Fax

Practice location:
  • Phone: 502-805-9699
  • Fax: 502-805-9664
Mailing address:
  • Phone: 502-805-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAM MITCHELL
Title or Position: OWNER/PROVIDER
Credential: PMHNP
Phone: 615-598-7643