Healthcare Provider Details

I. General information

NPI: 1093652257
Provider Name (Legal Business Name): BRILLIANT MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 45TH ST
HIGHLAND IN
46322-2902
US

IV. Provider business mailing address

2631 45TH ST
HIGHLAND IN
46322-2902
US

V. Phone/Fax

Practice location:
  • Phone: 219-515-0456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARISSA FESSENDEN
Title or Position: RBT
Credential:
Phone: 219-501-6520