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General NPI Number Information
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NPI Number | 1831989748
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Entity Type | Organization
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Legal Business Name | MINDGLOW MENTAL HEALTHCARE LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 610 N HIGH SCHOOL RD STE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3663
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Country | US
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Telephone | 317-496-7726
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Fax | 317-496-7726
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Provider Business Mailing Address
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Address Line | 3410 N HIGH SCHOOL RD SUIT G, PMB 1108
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City | INDIANAPOLIS
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State | IN
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Zip | 46224
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Country | US
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Telephone | 317-496-7726
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Fax | 317-496-7726
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Authorized Official
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Title or Position | OWNER
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Name | LANRE B OLANREWAJU
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Credential |
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Telephone | 317-496-7726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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