Healthcare Provider Details

I. General information

NPI: 1356959068
Provider Name (Legal Business Name): INDY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 WATERFRONT PARKWAY EAST DR STE 375
INDIANAPOLIS IN
46214-2026
US

IV. Provider business mailing address

2629 WATERFRONT PARKWAY EAST DR STE 375
INDIANAPOLIS IN
46214-2026
US

V. Phone/Fax

Practice location:
  • Phone: 317-978-0257
  • Fax: 317-974-9077
Mailing address:
  • Phone: 317-978-0257
  • Fax: 317-974-9077

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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SONYA KAY RUEDLINGER
Title or Position: CEO
Credential: APRN
Phone: 317-978-0257