| Mending Minds, Llc | |
|
1311 W 96th St Ste 110 Indianapolis IN 46260-1172 | |
| (317) 876-3699 | |
| (317) 876-3600 |
| Full Name | Mending Minds, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1311 W 96th St Ste 110, Indianapolis, Indiana |
| Authorized Official Name and Position | Lindsay Brooke Russell (OWNER) |
| Authorized Official Contact | 7654371458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mending Minds, Llc 1311 W 96th St Ste 110 Indianapolis IN 46260-1172 Ph: (317) 876-3699 | Mending Minds, Llc 1311 W 96th St Ste 110 Indianapolis IN 46260-1172 Ph: (317) 876-3699 |
| NPI Number | 1780258798 |
|---|---|
| Provider Enumeration Date | 05/14/2021 |
| Last Update Date | 05/14/2021 |
| Certification Date | 05/14/2021 |
| Medicare PECOS PAC ID | 4284037987 |
|---|---|
| Medicare Enrollment ID | O20210719001995 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780258798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Michael Pisano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336187103 PECOS PAC ID: 6406769546 Enrollment ID: I20031106000162 |
| Provider Name | Katherine M Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659315315 PECOS PAC ID: 4789775149 Enrollment ID: I20070814000653 |
| Provider Name | Carl Quedenfeld |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265476949 PECOS PAC ID: 7214086511 Enrollment ID: I20090515000323 |
| Provider Name | Lindsay B Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033660188 PECOS PAC ID: 0042594608 Enrollment ID: I20170227000381 |
| Provider Name | Kelly J Barsha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629636832 PECOS PAC ID: 7719211093 Enrollment ID: I20190619002610 |
| Provider Name | Christine E Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285923417 PECOS PAC ID: 1557765526 Enrollment ID: I20210812002891 |
| Provider Name | Zacia Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659099810 PECOS PAC ID: 1355727264 Enrollment ID: I20220929003258 |
| Provider Name | Amber Reann Phebus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639809528 PECOS PAC ID: 0042688178 Enrollment ID: I20221122000811 |
| Provider Name | Kimber Joy Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972236289 PECOS PAC ID: 2365811890 Enrollment ID: I20221206000538 |
| Provider Name | Valerie Hershberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861101909 PECOS PAC ID: 0941679112 Enrollment ID: I20221209001245 |
| Provider Name | Meko Kou Kokeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598431132 PECOS PAC ID: 9335511906 Enrollment ID: I20230207003314 |
| Provider Name | Jennifer Sue Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255039244 PECOS PAC ID: 4082069455 Enrollment ID: I20231005001397 |
| Provider Name | Jill Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841073228 PECOS PAC ID: 5193171353 Enrollment ID: I20231024001911 |
| Provider Name | Nicholas Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881382661 PECOS PAC ID: 0345699781 Enrollment ID: I20231212000149 |
| Provider Name | Shani Berrios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447026851 PECOS PAC ID: 2062859424 Enrollment ID: I20240320002805 |
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