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General NPI Number Information
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NPI Number | 1568383685
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Entity Type | Organization
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Legal Business Name | THE OTHER SIDE PSYCHIATRIC SERVICES,PLLC
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 1005 HIGHWAY 22 E
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City | OWENTON
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State | KY
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Zip | 40359-9041
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Country | US
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Telephone | 502-557-0776
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | OWENTON
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State | KY
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Zip | 40359-0036
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Country | US
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Telephone | 502-557-0776
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MRS. LABRISKA FAY HUMPHREY
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Credential | MSN,APRN,PMHNP-BC
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Telephone | 502-557-0776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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