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General NPI Number Information
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NPI Number | 1043913932
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Entity Type | Individual
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Provider Name | EMILY WALDO MS, NCC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 6337 CENTRAL AVE
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City | PORTAGE
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State | IN
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Zip | 46368-3801
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Country | US
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Telephone | 219-763-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 955 S COUNTY LINE RD
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City | WESTVILLE
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State | IN
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Zip | 46391-9500
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Country | US
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Telephone | 219-617-8644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39004430A
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License Number State | IN
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