| State Of Mind Therapy Services, Llc | |
|
55 Shore Dr Portage IN 46368-1008 | |
| (219) 230-8311 | |
| Not Available |
| Full Name | State Of Mind Therapy Services, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 55 Shore Dr, Portage, Indiana |
| Authorized Official Name and Position | Tiffany Kilroy (OWNER/THERAPIST) |
| Authorized Official Contact | 2192308311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Mind Therapy Services, Llc 709 Plaza Dr., Suite 2 Pmb 279 Chesterton IN 46304-1572 Ph: (219) 230-8311 | State Of Mind Therapy Services, Llc 55 Shore Dr Portage IN 46368-1008 Ph: (219) 230-8311 |
| NPI Number | 1083493761 |
|---|---|
| Provider Enumeration Date | 09/22/2023 |
| Last Update Date | 11/16/2023 |
| Certification Date | 11/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083493761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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