Provider Demographics
NPI:1639730955
Name:RISE MENTAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:RISE MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-575-0003
Mailing Address - Street 1:772 HIGHWAY 1258
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-5428
Mailing Address - Country:US
Mailing Address - Phone:606-575-0003
Mailing Address - Fax:
Practice Address - Street 1:1215 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2900
Practice Address - Country:US
Practice Address - Phone:606-575-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty