MEDICARE: FRE CLEAR MIND CENTER, INC.

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

General Provider Information

NPI Number	:	1669170684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRE CLEAR MIND CENTER, INC.

Provider Business Mailing Address
First Line	:	7734 KEMBLE CT
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14074 TRADE CENTER DR STE 145
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-4571
Country	:	US
Telephone Number	:	317-537-7330
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LAURA JEAN WELCH
Credential	:	LMHC
Telephone Number	:	317-537-7330

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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