MEDICARE: FLOURISH PSYCHOTHERAPY, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720939853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	1795 ALYSHEBA WAY STE 7202
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2481
Country	:	US
Telephone Number	:	855-591-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E COURT ST STE 350
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1201
Country	:	US
Telephone Number	:	855-591-0092
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	BRYANNA MINDERMANN
Credential	:
Telephone Number	:	855-591-0092

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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