Provider Demographics
NPI:1881431930
Name:MINDSET BEHAVIORAL HEALTH PC
Entity type:Organization
Organization Name:MINDSET BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HIZER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:317-554-7419
Mailing Address - Street 1:745 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-8994
Mailing Address - Country:US
Mailing Address - Phone:317-554-7419
Mailing Address - Fax:812-559-9192
Practice Address - Street 1:7230 ARBUCKLE CMNS STE 203
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1795
Practice Address - Country:US
Practice Address - Phone:317-554-7419
Practice Address - Fax:812-559-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300094818Medicaid