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General NPI Number Information
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NPI Number | 1811836752
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Entity Type | Organization
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Legal Business Name | PROSPERA PLLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 6900 HOUSTON RD STE 24
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City | FLORENCE
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State | KY
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Zip | 41042-4890
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Country | US
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Telephone | 859-250-9148
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 HOUSTON RD STE 24
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City | FLORENCE
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State | KY
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Zip | 41042-4890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANALISA HAGSTROM
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Credential | LPCC
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Telephone | 859-250-9148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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