Healthcare Provider Details

I. General information

NPI: 1720331705
Provider Name (Legal Business Name): ELISE MALLER MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14074 TRADE CENTER DR STE 206
FISHERS IN
46038-4573
US

IV. Provider business mailing address

14074 TRADE CENTER DR STE 206
FISHERS IN
46038-4573
US

V. Phone/Fax

Practice location:
  • Phone: 317-455-5291
  • Fax:
Mailing address:
  • Phone: 317-455-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002174A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: