AGELESS MINDS LLC NPI 1104769611

NPI Information

  • NPI: 1104769611
  • Provider Name: AGELESS MINDS LLC
  • Classification: Clinical Nurse Specialist - 364SP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 9165 OTIS AVE STE 164
    INDIANAPOLIS, IN
    ZIP 46216
  • Phone: (317) 930-1557

Map and Directions

Get Directions

NPI Details

AGELESS MINDS LLC is a psychiatric/mental health clinical nurse specialist in Indianapolis, IN. AGELESS MINDS LLC NPI is 1104769611. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9165 OTIS AVE STE 164
INDIANAPOLIS, IN
ZIP 46216-312
Phone: (317) 930-1557

The provider's authorized official is Queela Tadoum .
The authorized official title is Owner and has the following contact phone number (317) 930-1557.

The enumeration date for this NPI number is 4/10/2026 and was last updated on 4/10/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1364SP0808XClinical Nurse SpecialistPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI