Provider Demographics
NPI:1063131530
Name:STATE OF MIND THERAPY & COACHING LLC
Entity type:Organization
Organization Name:STATE OF MIND THERAPY & COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:317-680-8009
Mailing Address - Street 1:8150 E 550 S
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8608
Mailing Address - Country:US
Mailing Address - Phone:317-680-8009
Mailing Address - Fax:317-561-9006
Practice Address - Street 1:450 E 96TH ST STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3760
Practice Address - Country:US
Practice Address - Phone:317-680-8009
Practice Address - Fax:317-561-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty