Healthcare Provider Details

I. General information

NPI: 1639034200
Provider Name (Legal Business Name): SUSAN CANTIN COUNSELING AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14074 TRADE CENTER DR
FISHERS IN
46038-4563
US

IV. Provider business mailing address

12042 CABRI LN
FISHERS IN
46037-7809
US

V. Phone/Fax

Practice location:
  • Phone: 317-518-8170
  • Fax:
Mailing address:
  • Phone: 317-518-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUSAN CANTIN
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 317-518-8170