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General NPI Number Information
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NPI Number | 1962776906
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Entity Type | Individual
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Provider Name | KELLYE ECHTERNACH MA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 5638 PROFESSIONAL CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-5042
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Country | US
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Telephone | 317-247-8900
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Fax | 317-247-8935
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Provider Business Mailing Address
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Address Line | 5919 W LAKE DR APT A
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-7911
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Country | US
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Telephone | 217-653-8712
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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 | 39002618A
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License Number State | IN
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