=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831915537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH STUDEBAKER MA, LMHCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3562 EAST US 30
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-376-4489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4512 S WIGGER ST
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46953-5319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-213-6921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 88002425A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------