Provider Demographics
NPI:1083474449
Name:MINDCARE MENTAL HEALTH GROUP
Entity Type:Organization
Organization Name:MINDCARE MENTAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-498-6465
Mailing Address - Street 1:3091 SINGLETREE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9115
Mailing Address - Country:US
Mailing Address - Phone:270-498-6465
Mailing Address - Fax:
Practice Address - Street 1:3091 SINGLETREE DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-9115
Practice Address - Country:US
Practice Address - Phone:270-498-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty