Healthcare Provider Details

I. General information

NPI: 1710824040
Provider Name (Legal Business Name): LAILAH GUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

8606 ALLISONVILLE RD
INDIANAPOLIS IN
46250-5515
US

IV. Provider business mailing address

3633 KATELYN WAY
INDIANAPOLIS IN
46228-7023
US

V. Phone/Fax

Practice location:
  • Phone: 317-951-9358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88003209A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: