NPIMap

Organization Active NPI

Mindlift LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wilder, KY
National Provider Identifier
1013676345
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MINDLIFT LLC
Doing business as
MindLift LLC
Practice address
519 Licking Pike
Wilder, KY 41071-2941
Phone
(859) 572-0400
Fax
(859) 442-3363
NPI assigned
Dec 14, 2021
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Troy Duane Witte
Title
GM
Phone
(859) 655-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

519 Licking Pike
Wilder, KY 41071-2941

Mailing address

519 Licking Pike
Wilder, KY 41071-2941
Phone (859) 572-0400

Other names 1

  • MindLift LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231003001149 KY Part B Supplier - Clinic/Group Practice 1355795840 Receives reassigned benefits from 2 practitioners
Practice locations: Wilder, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1013676345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 LICKING PIKE",
            "city": "WILDER",
            "state": "KY",
            "postal_code": "410712941",
            "telephone_number": "859-572-0400",
            "fax_number": "859-442-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 LICKING PIKE",
            "city": "WILDER",
            "state": "KY",
            "postal_code": "410712941",
            "telephone_number": "859-572-0400",
            "fax_number": "859-442-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDLIFT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-14",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "WITTE",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "GM",
        "authorized_official_telephone_number": "859-655-6026",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MindLift LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MindLift LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilder, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.