Provider Demographics
NPI:1104451053
Name:LAUREL FAMILY MENTAL HEALTH
Entity type:Organization
Organization Name:LAUREL FAMILY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-657-5912
Mailing Address - Street 1:73 THOMPSON POYNTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7202
Mailing Address - Country:US
Mailing Address - Phone:606-657-5912
Mailing Address - Fax:606-657-5915
Practice Address - Street 1:73 THOMPSON POYNTER RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7202
Practice Address - Country:US
Practice Address - Phone:606-657-5912
Practice Address - Fax:606-657-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty