Healthcare Provider Details

I. General information

NPI: 1811218027
Provider Name (Legal Business Name): ELISABETH HENN-CARLSON MS, CHT, LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E 52ND ST STE 12
INDIANAPOLIS IN
46205-1176
US

IV. Provider business mailing address

740 E 52ND ST STE 12
INDIANAPOLIS IN
46205-1176
US

V. Phone/Fax

Practice location:
  • Phone: 317-921-0972
  • Fax:
Mailing address:
  • Phone: 317-921-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000922A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001142A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: