Provider Demographics
NPI:1417703893
Name:MIND YOUR MENTALITY
Entity type:Organization
Organization Name:MIND YOUR MENTALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-610-1181
Mailing Address - Street 1:221 SERENITY SHORES RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6043
Mailing Address - Country:US
Mailing Address - Phone:270-610-1181
Mailing Address - Fax:
Practice Address - Street 1:221 SERENITY SHORES RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-6043
Practice Address - Country:US
Practice Address - Phone:270-610-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty