Provider Demographics
NPI:1427866094
Name:WELL PSYCHOTHERAPY
Entity type:Organization
Organization Name:WELL PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-414-6088
Mailing Address - Street 1:237 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-4094
Mailing Address - Country:US
Mailing Address - Phone:859-414-6088
Mailing Address - Fax:606-727-9566
Practice Address - Street 1:237 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-4094
Practice Address - Country:US
Practice Address - Phone:859-414-6088
Practice Address - Fax:606-727-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100732450Medicaid
1831521798OtherNPI TYPE 1