Provider Demographics
NPI:1477371557
Name:RESILIENT MINDS LLC
Entity type:Organization
Organization Name:RESILIENT MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:TAMICKY
Authorized Official - Middle Name:TACHELL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:502-403-4365
Mailing Address - Street 1:2210 GOLDSMITH LANE
Mailing Address - Street 2:SUITE 126 PMB 4063
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218
Mailing Address - Country:US
Mailing Address - Phone:502-403-4365
Mailing Address - Fax:
Practice Address - Street 1:2210 GOLDSMITH LANE
Practice Address - Street 2:SUITE 126 PMB 4063
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-403-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily