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General NPI Number Information
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NPI Number | 1447973417
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Entity Type | Organization
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Legal Business Name | MINDIVE
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 119 S. SHERRIN AVE STE 240
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City | LOUISVILLE
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State | KY
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Zip | 40207-3237
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Country | US
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Telephone | 502-509-6002
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Fax | 502-415-7263
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Provider Business Mailing Address
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Address Line | 119 S. SHERRIN AVE STE 240
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City | LOUISVILLE
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State | KY
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Zip | 40207-3237
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Country | US
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Telephone | 502-645-6026
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Fax | 502-415-7263
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER DAVIS
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Credential |
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Telephone | 502-645-6026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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