Healthcare Provider Details

I. General information

NPI: 1831573732
Provider Name (Legal Business Name): SOMERSET MENTAL HEALTH, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 ENTERPRISE DR
SOMERSET KY
42501-6155
US

IV. Provider business mailing address

149 ENTERPRISE DR
SOMERSET KY
42501-6155
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-6995
  • Fax: 606-451-9465
Mailing address:
  • Phone: 606-679-6995
  • Fax: 606-451-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06202015
License Number StateKY

VIII. Authorized Official

Name: MR. JASON MICHAEL THAYER
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 606-679-6995