Healthcare Provider Details

I. General information

NPI: 1508591710
Provider Name (Legal Business Name): THINK WELL LIVE WELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 N SHADELAND AVE
INDIANAPOLIS IN
46250-2086
US

IV. Provider business mailing address

7202 N SHADELAND AVE
INDIANAPOLIS IN
46250-2086
US

V. Phone/Fax

Practice location:
  • Phone: 317-500-4789
  • Fax: 949-561-4566
Mailing address:
  • Phone: 317-500-4789
  • Fax: 949-561-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. REBECCA VANDENBURGH
Title or Position: OWNER
Credential: LCSW, LCAC
Phone: 317-500-4789