Healthcare Provider Details

I. General information

NPI: 1326935479
Provider Name (Legal Business Name): ELAYNA CANTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 E US HIGHWAY 36
AVON IN
46123-6645
US

IV. Provider business mailing address

1349 ECHO BEND ST
GREENWOOD IN
46142-1116
US

V. Phone/Fax

Practice location:
  • Phone: 888-714-1927
  • Fax:
Mailing address:
  • Phone: 317-694-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number000036486
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33012818A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: