| Mind Garden, Llc | |
|
450 E 96th St Indianapolis IN 46240-5703 | |
| (317) 760-3095 | |
| Not Available |
| Full Name | Mind Garden, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 450 E 96th St, Indianapolis, Indiana |
| Authorized Official Name and Position | Katheryn Lopshire (PRESIDENT) |
| Authorized Official Contact | 3177603095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Garden, Llc 450 E 96th St Indianapolis IN 46240-5703 Ph: () - | Mind Garden, Llc 450 E 96th St Indianapolis IN 46240-5703 Ph: (317) 760-3095 |
| NPI Number | 1598472276 |
|---|---|
| Provider Enumeration Date | 11/01/2022 |
| Last Update Date | 11/01/2022 |
| Certification Date | 11/01/2022 |
| Medicare PECOS PAC ID | 5092185355 |
|---|---|
| Medicare Enrollment ID | O20221230001539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598472276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katheryn Lopshire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538597281 PECOS PAC ID: 8820486657 Enrollment ID: I20211028001271 |
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