Provider Demographics
NPI:1528601705
Name:MENDING MINDS, LLC
Entity Type:Organization
Organization Name:MENDING MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-256-2239
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0575
Mailing Address - Country:US
Mailing Address - Phone:270-256-2239
Mailing Address - Fax:270-640-0207
Practice Address - Street 1:130 E WASHINGTON ST STE 117
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1178
Practice Address - Country:US
Practice Address - Phone:270-216-4026
Practice Address - Fax:270-640-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100440040Medicaid