Healthcare Provider Details

I. General information

NPI: 1952132854
Provider Name (Legal Business Name): MULBERRY THERAPEUTICS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN ST STE 227
PLAINFIELD IN
46168-2830
US

IV. Provider business mailing address

2680 E MAIN ST STE 227
PLAINFIELD IN
46168-2830
US

V. Phone/Fax

Practice location:
  • Phone: 765-787-1195
  • Fax:
Mailing address:
  • Phone: 765-787-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: COURTNEY NIKI DULA
Title or Position: CO-OWNER, THERAPIST
Credential: LCSW
Phone: 765-787-1196