Healthcare Provider Details

I. General information

NPI: 1245676931
Provider Name (Legal Business Name): AMANDA ZOLMAN MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 KENTUCKY AVE
INDIANAPOLIS IN
46221-2700
US

IV. Provider business mailing address

444 MONTGOMERY DR
WESTFIELD IN
46074-8811
US

V. Phone/Fax

Practice location:
  • Phone: 317-207-6301
  • Fax: 317-708-4904
Mailing address:
  • Phone: 317-207-6301
  • Fax: 317-708-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: