Provider Demographics
NPI:1043767254
Name:KESSLER, ELISABETH VIRGINIA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:VIRGINIA
Last Name:KESSLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:ELISABETH
Other - Middle Name:VIRGINIA
Other - Last Name:GIBBONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:6034 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2342
Mailing Address - Country:US
Mailing Address - Phone:317-408-3542
Mailing Address - Fax:
Practice Address - Street 1:6507 FERGUSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1294
Practice Address - Country:US
Practice Address - Phone:317-408-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002855A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health