Healthcare Provider Details

I. General information

NPI: 1457224933
Provider Name (Legal Business Name): ADHD LIFE MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12609 LARGO DR
FISHERS IN
46037-8189
US

IV. Provider business mailing address

12609 LARGO DR
FISHERS IN
46037-8189
US

V. Phone/Fax

Practice location:
  • Phone: 815-263-6149
  • Fax: 877-471-0404
Mailing address:
  • Phone: 815-263-6149
  • Fax: 877-471-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACIE MEYER
Title or Position: CEO/NURSE PRACTITIONER
Credential: AG-ACNP
Phone: 815-263-6149