Healthcare Provider Details

I. General information

NPI: 1982007423
Provider Name (Legal Business Name): ELIZABETH ANDRESEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST 7TH FLOOR
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

10330 N MERIDIAN ST SUITE 201
INDIANAPOLIS IN
46290-1024
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-3103
  • Fax: 317-338-3236
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042806A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: