Healthcare Provider Details

I. General information

NPI: 1124142070
Provider Name (Legal Business Name): MICHELE LYNN MARSH LCSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 CRAWFORDSVILLE RD STE 22
INDIANAPOLIS IN
46224-3727
US

IV. Provider business mailing address

205 PARTHENIA AVE
BROWNSBURG IN
46112-1131
US

V. Phone/Fax

Practice location:
  • Phone: 317-246-4016
  • Fax: 317-243-2328
Mailing address:
  • Phone: 317-858-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004055A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: