Healthcare Provider Details

I. General information

NPI: 1740169291
Provider Name (Legal Business Name): MIXON ADVERSITY WITH SUCCESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 SUMMERFIELD DR
INDIANAPOLIS IN
46214-1868
US

IV. Provider business mailing address

3210 SUMMERFIELD DR
INDIANAPOLIS IN
46214-1868
US

V. Phone/Fax

Practice location:
  • Phone: 317-490-1257
  • Fax:
Mailing address:
  • Phone: 317-490-1257
  • 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: BIANCA MIXON
Title or Position: OWNER
Credential: MSW
Phone: 317-490-1257