Healthcare Provider Details

I. General information

NPI: 1861492894
Provider Name (Legal Business Name): GISELE MARIE PLOOG LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N MAIN ST
CROWN POINT IN
46307-3278
US

IV. Provider business mailing address

250 N MAIN ST
CROWN POINT IN
46307-3278
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-6353
  • Fax: 219-663-1373
Mailing address:
  • Phone: 219-663-6353
  • Fax: 219-663-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: