Healthcare Provider Details

I. General information

NPI: 1538093240
Provider Name (Legal Business Name): PSYCHE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10340 W OLD NASHVILLE RD
COLUMBUS IN
47201-5076
US

IV. Provider business mailing address

10340 W OLD NASHVILLE RD
COLUMBUS IN
47201-5076
US

V. Phone/Fax

Practice location:
  • Phone: 317-800-2294
  • Fax:
Mailing address:
  • Phone: 317-800-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSI TODD
Title or Position: MEMBER
Credential: NP
Phone: 317-800-2294