Provider Demographics
NPI:1043913932
Name:WALDO, EMILY (MS, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALDO
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9500
Mailing Address - Country:US
Mailing Address - Phone:219-617-8644
Mailing Address - Fax:
Practice Address - Street 1:6337 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3801
Practice Address - Country:US
Practice Address - Phone:219-763-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004430A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health