NPIMap

Organization Active NPI

Midwest Behavioral Health LLC

Doing business as dba LifeStance Health

  • Psychiatry Physician
  • Evansville, IN
National Provider Identifier
1427362201
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
02001874A Issued in IN
Legal business name
MIDWEST BEHAVIORAL HEALTH LLC
Doing business as
dba LifeStance Health
Practice address
7300 E Indiana St
Suite 103
Evansville, IN 47715-2794
Phone
(812) 401-8008
NPI assigned
Aug 4, 2010
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Ryan Pardo
Title
Chief Legal Officer
Phone
(206) 399-1493

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 20040842A IN
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X 34000761A IN
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 02001874A IN Primary

Addresses

Primary practice location

7300 E Indiana St
Suite 103
Evansville, IN 47715-2794

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (253) 346-0392

Other names 1

  • dba LifeStance Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110824000118 IN Part B Supplier - Clinic/Group Practice 4587834874 Receives reassigned benefits from 166 practitioners
Practice locations: Carmel, IN; Avon, IN; Zionsville, IN; Mishawaka, IN; Indianapolis, IN; Evansville, IN; Fishers, IN

National Provider Directory

National Provider Directory

Locations

6845 E US Highway 36
Ste 500
Avon, IN 46123
Phone (317) 742-1340

7950 Ortho Ln
Ste 20
Brownsburg, IN 46112

11900 Pennsylvania St
Ste 104
Carmel, IN 46032
Phone (317) 663-2423

8205 E 56th St
Ste 200
Indianapolis, IN 46216
Phone (317) 554-4220

8470 Allison Pointe Blvd
Ste 130
Indianapolis, IN 46250
Phone (317) 554-4220

8920 Southpointe Dr
Ste E1
Indianapolis, IN 46227
Phone (317) 851-1004

3930 Edison Lakes Pkwy
Ste 320
Mishawaka, IN 46545
Phone (574) 305-2345

Practitioners & affiliated clinicians

Practitioners 176

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 176

NPI Registry JSON

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1427362201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "253-346-0392",
            "fax_number": "602-865-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 E INDIANA ST",
            "address_2": "SUITE 103",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152794",
            "telephone_number": "812-401-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-04",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "PARDO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "206-399-1493"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040842A",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "IN",
            "license": "34000761A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "02001874A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba LifeStance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.