MEDICARE: MINDFUL DIRECTION COUNSELING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	800195	KY
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386013001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL DIRECTION COUNSELING SERVICES INC

Provider Business Mailing Address
First Line	:	4602 SOUTHERN PKWY STE 2C
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-653-7439
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 SOUTHERN PKWY STE 2C
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-653-7439
Fax Number	:	855-894-9366

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. LETE M ANSERA
Credential	:	D.MIN, MFT, LCADC
Telephone Number	:	502-653-7439

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	08/18/2021

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