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General NPI Number Information
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NPI Number | 1417820986
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Entity Type | Organization
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Legal Business Name | STATES OF MIND
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1311 RING RD STE 105
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8963
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Country | US
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Telephone | 502-727-3865
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 LEGION ST
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City | WILBURTON
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State | PA
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Zip | 17888-7005
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Country | US
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Telephone | 502-727-3865
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST SPECIALIST
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Name | MRS. NANCY ELAINE ALLEN
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Credential | APRN
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Telephone | 502-727-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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