Provider Demographics
NPI:1114063781
Name:SALZMAN, ANLIZE KORSTS (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ANLIZE
Middle Name:KORSTS
Last Name:SALZMAN
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13295 ILLINOIS ST STE 324
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3022
Mailing Address - Country:US
Mailing Address - Phone:317-599-4501
Mailing Address - Fax:
Practice Address - Street 1:13295 ILLINOIS ST STE 324
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3022
Practice Address - Country:US
Practice Address - Phone:317-599-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042487A103T00000X, 103TH0100X
IN39001849A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000717019OtherANTHEM PIN