Healthcare Provider Details

I. General information

NPI: 1093727687
Provider Name (Legal Business Name): MARLA D MINTON MSSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N ROYAL AVE SUITE B
EVANSVILLE IN
47715-7845
US

IV. Provider business mailing address

PO BOX 8082
EVANSVILLE IN
47716-8082
US

V. Phone/Fax

Practice location:
  • Phone: 812-420-0020
  • Fax: 812-789-2458
Mailing address:
  • Phone: 812-420-0020
  • Fax: 812-789-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003950A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001064A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: