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General NPI Number Information
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NPI Number | 1073151239
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Entity Type | Individual
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Provider Name | TANICKA ELIZABETH WORD LMHCA
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Gender | Female
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 12125 E 65TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-4653
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Country | US
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Telephone | 312-248-4062
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 DEPAUW BLVD STE 3070
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-6135
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Country | US
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Telephone | 855-324-0885
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-88946
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88001966A
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License Number State | IN
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