MEDICARE: KINDRED WELLNESS COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720938350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED WELLNESS COMPANY

Provider Business Mailing Address
First Line	:	1113 E 86TH ST STE 207
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1811
Country	:	US
Telephone Number	:	317-662-4244
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 E BEVERLY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205
Country	:	US
Telephone Number	:	317-662-4244
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST/OWNER
Name	:	GRACE THEOFANIS
Credential	:	LMHC
Telephone Number	:	317-662-4244

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “KINDRED WELLNESS COMPANY ” Practice Location

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