Healthcare Provider Details

I. General information

NPI: 1841103785
Provider Name (Legal Business Name): ATHELAS PSYCHIATRY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 E 450 S
LA PORTE IN
46350-7624
US

IV. Provider business mailing address

2291 E 450 S
LA PORTE IN
46350-7624
US

V. Phone/Fax

Practice location:
  • Phone: 219-575-2554
  • Fax:
Mailing address:
  • Phone: 219-575-2554
  • Fax:

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: RUTH RYDER
Title or Position: OWNER
Credential:
Phone: 219-575-2554