Provider Demographics
NPI:1417287624
Name:HARRELL, AIMEE LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNNE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DRUZE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8259
Mailing Address - Country:US
Mailing Address - Phone:765-588-7196
Mailing Address - Fax:
Practice Address - Street 1:4010 DRUZE AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8259
Practice Address - Country:US
Practice Address - Phone:765-588-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005464A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical