# THE MENTAL BISTRO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649003716
- **Authorized official:** ASHLEY KIMBROUGH LICSW-S;PIP (THERAPIST/OWNER)
- **Authorized official phone:** (256) 436-7460

## Contact information

- **Practice address:** 6595 HIGHWAY 43 BLDG D, SPRUCE PINE, AL 35585-4223
- **Practice address phone:** (256) 436-7460
- **Mailing address:** 6595 HIGHWAY 43 BLDG D, SPRUCE PINE, AL 35585-4223
- **Mailing address phone:** (256) 436-7460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2024
- **Last updated:** 08/23/2024