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NPI Code Detail

MEDICARE: MENDING MINDS, LLC

MEDICARE: MENDING MINDS, LLC
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1780258798
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDING MINDS, LLC
Provider Business Mailing Address
First Line : 1311 W 96TH ST STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1172
Country : US
Telephone Number : 317-876-3699
Fax Number : 317-876-3600
Provider Business Practice Location Address
First Line : 1311 W 96TH ST STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1172
Country : US
Telephone Number : 317-876-3699
Fax Number : 317-876-3600
Authorized Official
Title or Position : OWNER
Name : LINDSAY BROOKE RUSSELL
Credential : PMHNP
Telephone Number : 765-453-7422
Provider Enumeration Date : 05/14/2021
Last Update Date : 04/08/2025

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Directions to “MENDING MINDS, LLC ” Practice Location

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