MEDICARE: HUMBLE HUMILITY MENTAL HEALTH P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084P0805X	Geriatric Psychiatry Physician
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396458097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBLE HUMILITY MENTAL HEALTH P.C.

Provider Business Mailing Address
First Line	:	6101 N. KEYSTONE AVE.
Second Line	:	SUITE 100 #1370
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220
Country	:	US
Telephone Number	:	317-983-9945
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE STE 369
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3873
Country	:	US
Telephone Number	:	317-983-9945
Fax Number	:	463-271-7786

Authorized Official
Title or Position	:	CEO
Name	:	LATOYA C EVANS
Credential	:
Telephone Number	:	317-983-9945

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	03/26/2023

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