Healthcare Provider Details

I. General information

NPI: 1326661836
Provider Name (Legal Business Name): BRIDGE CLINICS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 E 10TH ST
INDIANAPOLIS IN
46201-2554
US

IV. Provider business mailing address

6357 ROCKVILLE RD
INDIANAPOLIS IN
46214-3920
US

V. Phone/Fax

Practice location:
  • Phone: 317-757-2563
  • Fax: 317-405-9970
Mailing address:
  • Phone: 317-757-2563
  • Fax: 317-405-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATIFAT A. OYEKOLA
Title or Position: OWNER
Credential: MD
Phone: 317-495-5173