Provider Demographics
NPI:1831989748
Name:MINDGLOW MENTAL HEALTHCARE LLC
Entity type:Organization
Organization Name:MINDGLOW MENTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANRE
Authorized Official - Middle Name:B
Authorized Official - Last Name:OLANREWAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-496-7726
Mailing Address - Street 1:3410 N HIGH SCHOOL RD
Mailing Address - Street 2:SUIT G, PMB 1108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-496-7726
Mailing Address - Fax:317-496-7726
Practice Address - Street 1:610 N HIGH SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3663
Practice Address - Country:US
Practice Address - Phone:317-496-7726
Practice Address - Fax:317-496-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty