Healthcare Provider Details

I. General information

NPI: 1376457630
Provider Name (Legal Business Name): YOUR LIFE REIMAGINED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 ONTARIO CIR
INDIANAPOLIS IN
46268-1981
US

IV. Provider business mailing address

3704 ONTARIO CIR
INDIANAPOLIS IN
46268-1981
US

V. Phone/Fax

Practice location:
  • Phone: 317-627-6701
  • Fax:
Mailing address:
  • Phone: 317-627-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. CELEST TOLES KEYS
Title or Position: PSYCH NURSE PRACTITIONER
Credential: MSN APRN PMHNP-BC
Phone: 317-627-6701