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General NPI Number Information
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NPI Number | 1508591710
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Entity Type | Organization
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Legal Business Name | THINK WELL LIVE WELL
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7202 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2086
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Country | US
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Telephone | 317-500-4789
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Fax | 949-561-4566
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Provider Business Mailing Address
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Address Line | 7202 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2086
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Country | US
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Telephone | 317-500-4789
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Fax | 949-561-4566
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Authorized Official
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Title or Position | OWNER
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Name | MS. REBECCA VANDENBURGH
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Credential | LCSW, LCAC
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Telephone | 317-500-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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