MEDICARE: MS. MIMI M BRITTINGHAM LMFT, LMHC, CNS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	39000787A	IN
2	101YP2500X	Professional Counselor	39000787A	IN
3	106H00000X	Marriage & Family Therapist	35000985A	IN
4	364S00000X	Clinical Nurse Specialist	70000166A	IN
5	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	70000166A	IN

General Provider Information

NPI Number	:	1447262746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIMI M BRITTINGHAM LMFT, LMHC, CNS

Provider Business Mailing Address
First Line	:	210 E 91ST ST
Second Line	:	SUITE C
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1569
Country	:	US
Telephone Number	:	317-844-0055
Fax Number	:	317-571-5040

Provider Business Practice Location Address
First Line	:	210 E 91ST ST
Second Line	:	SUITE C
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1569
Country	:	US
Telephone Number	:	317-844-0055
Fax Number	:	317-571-5040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/11/2025

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