Healthcare Provider Details

I. General information

NPI: 1134040520
Provider Name (Legal Business Name): COGNICORE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 N KEYSTONE AVE STE
INDIANAPOLIS IN
46220-2488
US

IV. Provider business mailing address

6101 N KEYSTONE AVE STE
INDIANAPOLIS IN
46220-2488
US

V. Phone/Fax

Practice location:
  • Phone: 317-624-2004
  • Fax:
Mailing address:
  • Phone: 317-624-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JORDAN MACKLIN
Title or Position: CEO/FOUNDER
Credential: LMHC
Phone: 317-908-3466