Provider Demographics
NPI:1073797296
Name:TRUSTY-SMITH, CARLA ELLEN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ELLEN
Last Name:TRUSTY-SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 NORTH CARROLLTON AVE.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220
Mailing Address - Country:US
Mailing Address - Phone:317-251-6251
Mailing Address - Fax:317-255-8176
Practice Address - Street 1:6524 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1617
Practice Address - Country:US
Practice Address - Phone:317-251-6251
Practice Address - Fax:317-255-8176
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001288A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health