Healthcare Provider Details

I. General information

NPI: 1578498705
Provider Name (Legal Business Name): ELEVATE MENTAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 E STOP 11 RD STE 1
INDIANAPOLIS IN
46237-8618
US

IV. Provider business mailing address

5162 E STOP 11 RD STE 1
INDIANAPOLIS IN
46237-8618
US

V. Phone/Fax

Practice location:
  • Phone: 443-452-3678
  • Fax:
Mailing address:
  • Phone: 317-426-7368
  • Fax: 317-659-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN CLYNE
Title or Position: NURSE PRACTITIONER
Credential: PMHNP, ANP
Phone: 317-426-7368