Organization
DAVIKA MATTOX PMHNP RECOVERY AND WELLNESS BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVIKA MATTOX (OWNER)
(859) 432-2168
Entity
Organization
Contact information
Practice address
3208 POLO CLUB BLVD, LEXINGTON, KY 40509-8454
(859) 432-2168
Mailing address
3208 POLO CLUB BLVD, LEXINGTON, KY 40509-8454
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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