Healthcare Provider Details

I. General information

NPI: 1063384923
Provider Name (Legal Business Name): MINDI WISKER-TINDALL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N WALNUT ST STE 700
BLOOMINGTON IN
47404-2008
US

IV. Provider business mailing address

5696 S NATURE TRAIL DR
BLOOMINGTON IN
47403-8866
US

V. Phone/Fax

Practice location:
  • Phone: 812-727-4030
  • Fax:
Mailing address:
  • Phone: 812-727-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MINDI WISKER-TINDALL
Title or Position: MEMBER/OWNER
Credential: LMHC, LCPC
Phone: 812-727-4030