The Mental Health Spa, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THE MENTAL HEALTH SPA, LLC

Practice address

1311 W 96TH St Ste 175
Indianapolis, IN 46260-1339

Phone

(317) 619-9485

NPI assigned

Jul 18, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cydaria Lashon Cooke, MBA, MSW, LCSWNPI 1477167815

Title

Owner

Phone

(317) 619-9485

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cydaria Lashon Cooke, MBA, MSW, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1477167815
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1104664564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7909 PRESERVATION DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462789553",
            "telephone_number": "317-619-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 W 96TH ST STE 175",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601339",
            "telephone_number": "317-619-9485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7909 Preservation Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462789553",
            "country_code": "US",
            "telephone_number": "317-619-9485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE MENTAL HEALTH SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "COOKE",
        "authorized_official_first_name": "CYDARIA",
        "authorized_official_middle_name": "LASHON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-619-9485",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA, MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.