# STATE OF MIND THERAPY SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083493761
- **Authorized official:** TIFFANY KILROY LMHC (OWNER/THERAPIST)
- **Authorized official phone:** (219) 230-8311

## Contact information

- **Practice address:** 55 SHORE DR, PORTAGE, IN 46368-1008
- **Practice address phone:** (219) 230-8311
- **Mailing address:** 709 PLAZA DR., SUITE 2 PMB 279, CHESTERTON, IN 46304-1572
- **Mailing address phone:** (219) 230-8311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | Yes |
| 101YP2500X | Professional Counselor | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2023
- **Last updated:** 11/16/2023