Healthcare Provider Details

I. General information

NPI: 1235908047
Provider Name (Legal Business Name): ELENI GUOLI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BUNTIN ST
VINCENNES IN
47591-1320
US

IV. Provider business mailing address

121 BUNTIN ST
VINCENNES IN
47591-1320
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-8622
  • Fax:
Mailing address:
  • Phone: 812-885-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004797A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: