Healthcare Provider Details

I. General information

NPI: 1891722146
Provider Name (Legal Business Name): SOMERSET MENTAL HEALTH, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/06/2017
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 TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. JASON M THAYER
Title or Position: ADMINISTRATOR
Credential: LCSW
Phone: 606-679-6995