Provider Demographics
NPI:1588299580
Name:MINORITY MENTAL HEALTH PROJECT
Entity type:Organization
Organization Name:MINORITY MENTAL HEALTH PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:502-403-5921
Mailing Address - Street 1:642 S 2ND ST APT 1007
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2443
Mailing Address - Country:US
Mailing Address - Phone:502-403-5921
Mailing Address - Fax:
Practice Address - Street 1:642 S 2ND ST APT 1007
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2443
Practice Address - Country:US
Practice Address - Phone:502-403-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health