Healthcare Provider Details

I. General information

NPI: 1447036991
Provider Name (Legal Business Name): MINDFUL TREK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LOGAN ST STE 110
NOBLESVILLE IN
46060-2253
US

IV. Provider business mailing address

3419 N PENNSYLVANIA ST APT D1
INDIANAPOLIS IN
46205-3443
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-4798
  • Fax:
Mailing address:
  • Phone: 317-489-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY REED
Title or Position: OWNER
Credential: LCSW
Phone: 317-296-4798