MEDICARE: STARKS MENTAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558077818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARKS MENTAL HEALTH

Provider Business Mailing Address
First Line	:	6101 N KEYSTONE AVE STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2499
Country	:	US
Telephone Number	:	317-730-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4926 COMMON VISTA CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-5394
Country	:	US
Telephone Number	:	317-730-0023
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	PHYLLIS STARKS
Credential	:
Telephone Number	:	317-730-0023

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “STARKS MENTAL HEALTH ” Practice Location

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