Provider Demographics
NPI:1245778893
Name:MINDSIGHT BEHAVIORAL
Entity type:Organization
Organization Name:MINDSIGHT BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPA
Authorized Official - Prefix:MS
Authorized Official - First Name:ANASTACIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUDGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:606-383-0728
Mailing Address - Street 1:170 PRATHER RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 PRATHER RD
Practice Address - Street 2:UNIT 1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6307
Practice Address - Country:US
Practice Address - Phone:606-875-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health