Organization
MINDCLUB KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY RICHARDSON (VP, CAO)
(615) 390-2865
Entity
Organization
Contact information
Practice address
111 DERRICK PL, HOPKINSVILLE, KY 42240-1325
(833) 833-9655
Mailing address
106 MISSION CT STE 201A, FRANKLIN, TN 37067-6441
(153) 902-8656
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/16/2025
Last updated
06/16/2025
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