Provider Demographics
NPI:1083463442
Name:MENTAL HELP PROVIDER LLC
Entity type:Organization
Organization Name:MENTAL HELP PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKEH
Authorized Official - Suffix:
Authorized Official - Credentials:MN
Authorized Official - Phone:317-529-2372
Mailing Address - Street 1:3306 CLARY BLVD SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-5524
Mailing Address - Country:US
Mailing Address - Phone:317-529-2372
Mailing Address - Fax:
Practice Address - Street 1:6640 PARKDALE PL STE V
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5619
Practice Address - Country:US
Practice Address - Phone:317-529-2372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty