THERAPEUTIC COLLABORATIVE NPI 1629123443

NPI Information

NPI: 1629123443
Provider Name: THERAPEUTIC COLLABORATIVE
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

Address:
519 LICKING PIKE
WILDER, KY
ZIP 41071
Phone: (859) 572-0400
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THERAPEUTIC COLLABORATIVE is an adolescent and children mental health clinic center in Wilder, KY. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. THERAPEUTIC COLLABORATIVE NPI is 1629123443. The provider is registered as an organization entity type.

The provider's business location address is:

519 LICKING PIKE
WILDER, KY
ZIP 41071
Phone: (859) 572-0400
Fax: (859) 442-3363

The provider's authorized official is Virginia Ellen Peppers .
The authorized official title is Partner and has the following contact phone number (859) 572-0400.

The enumeration date for this NPI number is 1/24/2007 and was last updated on 6/17/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	No
2	364SP0807X	Clinical Nurse Specialist	Psychiatric/Mental Health, Child & Adolescent	No
3	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	65928897	MEDICAID	KENTUCKY
2	0385301	MEDICARE ID-TYPE UNSPECIFIED	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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