Healthcare Provider Details

I. General information

NPI: 1871029983
Provider Name (Legal Business Name): MINDI WISKER-TINDALL LMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
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

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

V. Phone/Fax

Practice location:
  • Phone: 812-727-4030
  • Fax:
Mailing address:
  • Phone: 812-727-4030
  • Fax: 812-289-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC04323
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: