MEDICARE: MINDCLUB BEHAVIORAL HEALTH PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	363LP2300X	Primary Care Nurse Practitioner
3	101Y00000X	Counselor
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407717820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDCLUB BEHAVIORAL HEALTH PA

Provider Business Mailing Address
First Line	:	106 MISSION CT STE 201A
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6441
Country	:	US
Telephone Number	:	615-390-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 MISSION CT STE 201A
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6441
Country	:	US
Telephone Number	:	615-390-2865
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	KATHY RICHARDSON
Credential	:
Telephone Number	:	615-390-2865

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	01/12/2026

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