=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174064497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY MINDS COUNSELING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2017
-----------------------------------------------------
Last Update Date | 03/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 LAWRENCEBURG RD BUILDING B, SUITE 4
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-9128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-783-6030
-----------------------------------------------------
Fax | 855-727-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 LAWRENCEBURG RD BUILDING B, SUITE 4
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-9128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-783-6030
-----------------------------------------------------
Fax | 855-727-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-PRESIDENT
-----------------------------------------------------
Name | MS. KRISTINA ELIZABETH HAYDEN
-----------------------------------------------------
Credential | LPCA
-----------------------------------------------------
Telephone | 502-783-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 127944
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------