Provider Demographics
NPI:1295553816
Name:NOURISH MENTAL HEALTH
Entity type:Organization
Organization Name:NOURISH MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:615-598-7643
Mailing Address - Street 1:3014 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9615
Mailing Address - Country:US
Mailing Address - Phone:502-805-9699
Mailing Address - Fax:
Practice Address - Street 1:7600 W HIGHWAY 146 STE 200
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056-8110
Practice Address - Country:US
Practice Address - Phone:502-805-9699
Practice Address - Fax:502-805-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty