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General NPI Number Information
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NPI Number | 1215753736
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Entity Type | Organization
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Legal Business Name | THE MIND NEST LLC
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 4120 SAINT JOSEPH RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-9750
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Country | US
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Telephone | 812-227-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 ASHBURY DR
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City | NEW ALBANY
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State | IN
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Zip | 47150-6581
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAITLIN FONDREN
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Credential | PHD
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Telephone | 812-989-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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