Healthcare Provider Details

I. General information

NPI: 1396458097
Provider Name (Legal Business Name): HUMBLE HUMILITY MENTAL HEALTH P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 03/26/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S STATE AVE STE 369
INDIANAPOLIS IN
46201-3873
US

IV. Provider business mailing address

6101 N. KEYSTONE AVE. SUITE 100 #1370
INDIANAPOLIS IN
46220
US

V. Phone/Fax

Practice location:
  • Phone: 317-983-9945
  • Fax: 463-271-7786
Mailing address:
  • Phone: 317-983-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LATOYA C EVANS
Title or Position: CEO
Credential:
Phone: 317-983-9945