Healthcare Provider Details

I. General information

NPI: 1265203285
Provider Name (Legal Business Name): SOUND MIND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 LESTER HIGHWAY
LESTER WV
25865
US

IV. Provider business mailing address

PO BOX 63
LESTER WV
25865-0063
US

V. Phone/Fax

Practice location:
  • Phone: 304-712-0775
  • Fax:
Mailing address:
  • Phone: 304-712-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ROBERT BAILEY
Title or Position: CLINICAL OPERATIONS MANAGER
Credential: MS
Phone: 304-712-0775