Provider Demographics
NPI:1376152728
Name:LIMITLESS MINDS LLC.
Entity Type:Organization
Organization Name:LIMITLESS MINDS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-288-5036
Mailing Address - Street 1:PO BOX 1655
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-1655
Mailing Address - Country:US
Mailing Address - Phone:270-288-5036
Mailing Address - Fax:270-288-5082
Practice Address - Street 1:1118 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9409
Practice Address - Country:US
Practice Address - Phone:270-288-5036
Practice Address - Fax:270-228-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1689145971Medicaid