Provider Demographics
NPI:1326578006
Name:HUMAN NATURE, LLC
Entity Type:Organization
Organization Name:HUMAN NATURE, LLC
Other - Org Name:CROSSFIT R837
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:270-904-4088
Mailing Address - Street 1:668 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3833
Mailing Address - Country:US
Mailing Address - Phone:270-996-7400
Mailing Address - Fax:
Practice Address - Street 1:1960 LOUISVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1254
Practice Address - Country:US
Practice Address - Phone:270-904-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106719261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)