Mindlift LLC
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Wilder, KY
NPI 1013676345 · NPPES record last updated Oct 12, 2023
Key facts
- NPI
- 1013676345
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- MINDLIFT LLC
- Practice address
- 519 Licking Pike
Wilder, KY 41071-2941 - Phone
- (859) 572-0400
- Fax
- (859) 442-3363
- NPI assigned
- Dec 14, 2021
- Organization subpart
- No
Authorized official
- Name
- Mr. Troy Duane Witte
- Title
- GM
- Phone
- (859) 655-6026
Practitioners 4
-
Madija J. Sandy, MSN, PMHNP
-
Charlotte Savill, RN MSN PMHNP-C
-
Lonna L Larger, MSN, PMHNP-BC
-
Pamela Marie McCarthy, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231003001149 | KY | Part B Supplier - Clinic/Group Practice | 1355795840 |
Receives reassigned benefits from 2 practitioners Practice locations: Wilder, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100926170 | Medicaid | KY |
Other names
- MindLift LLC
Other providers in Wilder, KY
- Lifes Journey Therapy and Counseling PLLC
- Amanda Mae
- Tiffany Maple
- Akiko Marui
- Pamela Marie McCarthy
- Julie Ann Mosley
- Elizabeth Diane Moussas
- Christina Nash
- Savannah Leimomi O'Banion
- Patient AIDS Inc
All providers in Wilder, KY · Mental Health Clinic/Center (Including Community Mental Health Center) in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.