Provider Demographics
NPI:1326837717
Name:ATILGAB PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:ATILGAB PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:OLUGBENGA
Authorized Official - Last Name:ATILOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-507-1419
Mailing Address - Street 1:2346 S LYNHURST DR STE C201B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5104
Mailing Address - Country:US
Mailing Address - Phone:317-507-1419
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR STE C201B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5104
Practice Address - Country:US
Practice Address - Phone:317-507-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)