Provider Demographics
NPI:1417057662
Name:VANTASSEL, ELIZABETH BUTLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BUTLER
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10293 N MERIDIAN ST
Mailing Address - Street 2:STE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1073
Mailing Address - Country:US
Mailing Address - Phone:317-573-0748
Mailing Address - Fax:317-853-1314
Practice Address - Street 1:10293 N MERIDIAN ST
Practice Address - Street 2:STE 180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1073
Practice Address - Country:US
Practice Address - Phone:317-503-7548
Practice Address - Fax:317-853-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN20010401A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist